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ENT · Larynx and airway: voice prosthesis leakage
Sample itemMonths after a total laryngectomy with a tracheoesophageal voice prosthesis, a patient coughs whenever he drinks, and fluid is seen leaking through the lumen of the prosthesis. What is the commonest cause?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Candida colonisation of the silicone valve
Fungal colonisation of the silicone valve, mainly Candida, stops the flap closing and causes leakage through the prosthesis. Treatment is replacing the prosthesis, cleaning, and sometimes antifungal therapy. Leakage around the prosthesis suggests an enlarged tract or wrong length.
Option by option
A. Recurrent laryngeal tumour at the stoma
Tumour recurrence does not make the valve incompetent.
B. Radiation fibrosis of the pharynx
Radiation fibrosis affects the tissues around the device and not the valve.
C. Prosthesis that is too short
A short prosthesis tends to cause leakage around, not through, the device.
D. Candida colonisation of the silicone valve (correct)
Correct. Candida growth on the valve prevents closure and causes leakage through the device.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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