To the Editor.—Mahieu et al1 recently reported that Candida albicans was responsible for early deterioration of silicone voice prostheses used in a tracheoesophageal fistula for postlaryngectomy voice restoration. Fungal vegetations on the prosthesis prevented competent valve closure, causing aspiration. Prosthesis durability was reduced from an average of three months to just a few weeks. We have also identified Candida on the esophageal surface of silicone voice prostheses used by a significant number of our patients. They report inability to remove these deposits by routine cleaning methods and device leakage after three to four weeks' use. In two patients selected for study, Candida deposits embedded in the porous silicone surface appeared within a week of use, and proliferation interfered with valve function as early as 21 and 28 days, respectively.
As an alternative to eradication of Candida in the host, we suggest disinfecting the prosthesis with an antifungal agent