Influence of Probiotic Administration on Tracheoesophageal Voice Prosthesis's Function and Microbial Colonisation: A Pilot Study

INTRO: Tracheoesophageal voice prosthesis (VP) is an effective method for restoring fluent speech after total laryngectomy, but its microbial colonisation can impair device performance. Aims of this study are to characterise VP microbiological colonisation in laryngectomised patients and assess whether regular probiotic supplementation, plus VP management, could reduce VP contamination, improving function and durability. METHODS: A total of 34 patients were enrolled; 15 received standard VP hygiene and management with nystatin four times/day for 5 days before and 5 days after each VP replacement (Group 1) and 19 received the same protocol as Group 1, plus a probiotic supplement (VSL#3, Actial Farmaceutica SRL, Rome, Italy) for 10 days each month throughout the observation period (Group 2). All removed VPs were cultured. Patients underwent a brief questionnaire regarding the VP functionality. RESULTS: Each patient of both groups had a single VP substitution. The most frequently isolated were Pseudomonas aeruginosa, Staphylococcus aureus and Candida species. When comparing VP microbial cultures at baseline and follow-up, no significant differences were observed in Group 1, while in Group 2, a significant reduction in the detection of multiple microbial species at follow-up was detected. Specifically, a significant decrease was observed in the prevalence of S. aureus methicillin-sensitive (p = 0.05), miscellaneous Gram-negative bacteria (p = 0.04) and Candida albicans (p = 0.02). Survey results showed a significant overall improvement in VP functionality in Group 2 versus Group 1 (p = 0.008). CONCLUSION: Microbiological findings and patient opinions suggest a positive impact of probiotics on reducing bacterial contamination and improving VP functionality.