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Title: Longitudinal investigation of mixed-species biofilm formation and its effect on device longevity in patients using voice prostheses
Author: Okoliegbe, Ijeoma Nnenna
ISNI:       0000 0004 7228 7258
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2018
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In the UK, there are up to 3,000 cancer patients who have undergone total laryngectomy and use voice prostheses (VPs), for speech rehabilitation. VPs are inserted between the eosphagus and trachea to provide a 'voice' but, as with other semi-in-dwelling devices, such as nasal and gastric tubes, they invariably fail due to occlusion by microbial biofilms. The requirement for frequent replacement is financially costly to the NHS and impacts patient well-being. Replacement frequency varies by patient, from 7 weeks to 6 months but the reasons for this variation are not clearly understood. By designing and implementing a study of microbial colonisation of VPs and oral rinse samples submitted by 14 Speech and Voice Clinic patients over 13 months, this study explored whether specific microbes or patient factors, including the use of antacids, antibiotics and nystatin, along with denture-use, were potential predictors of device longevity. Focussing on the role of the commonly isolated fungi, we sought to understand the role of diet or the presence of the bacterium, S. aureus, in biomass accumulation. We also asked whether biofilm regulation pathways are shared across the fungi and could constitute a potential target for therapeutics. Microbial isolation from 66 VPs showed the predominant species as described in previous studies, but each participant had a unique profile which persisted over time, with half of the microbes originating from the oral flora. Clinic-based participants experienced fewer problems, primarily due to the device type used, and carried fewer species of Gram negative bacteria than the long term users. Statistical analysis showed that patient medication influences biofilm composition and dietary sugars differentially affect biomass formation. In vitro experiments showed that the ability to treat Candida biofilms with nystatin was improved in the presence of S. aureus. Expression analysis showed that regulation of biofilms in C. parapsilosis was the closest to that of C. albicans but that the extent of protein homology to C. albicans regulators was not a predictor of expression levels. It is therefore unlikely that a single therapeutic could be developed to target biofilm gene regulation. This work provides new insights into the complexity of biofilm formation in voice prosthesis users but reveals associations between microbes, diet, prosthesis type and medications that might be used to advise patients and help to reduce the stress and cost of frequent device failure and replacement.
Supervisor: Not available Sponsor: University of Aberdeen
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Artificial larynx ; Biofilms ; Nystatin