Candida overgrowth of the prosthesis is a phenomenon occurring in almost all patients. A typical example is shown in the figure to the right. As long as there is no leakage through the prosthesis caused by candida deposits, there is no reason for special action. The mere presence of candida by itself is not a reason for replacement of the prosthesis. However, if frequent replacements of the prosthesis are needed due to candida overgrowth, some form of treatment with antifungal agents might be considered (3-6). We prefer to use mycostatin (nystatin) oral solution, which also could be applied topically with the cleaning brush directly into the prosthesis. In some patients an improved device life was observed with this method. In case of very early leakage, the provox activalve is a better solution increasing device life 8-10 times.
The upper figure to the left shows an example of a prosthesis “treated” with mycostatin during 5 months, only applied with the brush. Only on top of the prosthesis, not reached with the brush, excessive candida vegetations are present. The valve became incompetent because of a small candida deposit on the free edge of the valve. The next figure shows an endoscopic view of a voice prosthesis with candida deposits just prior to replacement.