Very frequent replacement due to leakage

This very short device-life can be caused either by rapid overgrowth of candida, leading to incompetence of the valve mechanism or underpressure in the esophagus during inhaling or swallowing. This is sometimes caused by stenosis in the neopharynx. Aside from prescription of anti-candida medication to put on the brush, as described above, there is laboratory and clinical evidence that dietary changes might influence the device-life of a voice prosthesis (7-10). Although biofilm formation is the first step to candida adherence and growth on the silicon material of the device, it seems that the consumption of probiotic dietary products can decrease the ‘candida burden’ in the pharynx and esophagus. It can be worthwhile to ask the patient about their dietary habits, and suggest changes in case rapid candida overgrowth seems the cause of a short device life. There is also anecdotal evidence that diminishing the consumption of ‘candida or yeast rich food’, such as beer and certain cheeses might decrease this problem as well. In case these measures do not work, the provox activalve which uses a magnet for valve closure and has a 8-10 time longer device life is a good solution. In case opening of the valve is seen at swallowing or breathing, an activalve strong is probably the prosthesis of choice