Objectives/Hypothesis The objective of this study was to evaluate the effectiveness of nystatin and Biotène® mouthwash Oral Rinse for controlling Candida in total laryngectomy (TL) patients with a tracheosophageal voice prosthesis (TEP) because Biotène® mouthwash Oral Rinse is a less costly alternative to nystatin and requires less adherence time. Study Design Randomized, unblinded, crossover trial. Methods Twenty-one TL patients were randomized to receive nystatin followed by Biotène® mouthwash Oral Rinse, or the reverse order, after a basic oral-care phase (i.e., brushing teeth, cleaning dentures). A Provox® 2, 22.5 French TEP, which is an indwelling silicone voice prosthesis, was placed at the beginning of each phase. Patients were provided with oral care instructions at randomization and medication-specific instructions with each treatment's initiation. TEPs were processed and evaluated for Candida growth as colony-forming units (CFUs). Wilcoxon signed-rank tests were used for comparisons between treatments. Results Fifteen patients were available for comparisons of Candida counts (6 received nystatin; 9 received Biotène® mouthwash first). Overall, the median log10 (CFUs) remained high regardless of treatment (no medication: 8.9; nystatin: 8.7; Biotène® mouthwash: 8.4). However, the median counts for both nystatin and Biotène® mouthwash Oral Rinse were lower than those for no medication (difference [Δ]:-0.9 and -0.3, respectively), although only nystatin was significantly lower (P=0.02). There was no significant difference between the two treatments (P=0.22). Overall, median medication-adherence was high (97%), and Biotène® mouthwash adherence was significantly higher than that of nystatin (Δ: 7.6%; P=0.03). Conclusion Nystatin and Biotène® mouthwash Oral Rinse had similar CFU levels, with nystatin showing a significant improvement over usual oral care. Biotène® mouthwash is a less costly alternative to nystatin, with a less complex treatment protocol that might make it preferable to patients and clinicians.
- Biotène mouthwash
- tracheoesophageal voice prosthesis
ASJC Scopus subject areas