[Oral medicine 5. Dietary counselling and psycho-social aspects of chemosensory disorders]. / Oral medicine 5. Voedingsadviezen bij en psychosociale aspecten van smaak - en reukstoornissen.

Chemosensory disorders may result in loss of body weight and sometimes in gain of body weight. Therefore, dietary advice is an essential part of the counselling and treatment ofpatients with a chemosensory disorder. In cases involving a chemosensory disorder, a distinction has to be made between general dietary advice and advice during and after a patient's period of chemotherapy or radiotherapy. The aim of dietary advice is the improvement ofa patient's nutritional condition and the patient's well-being. In case of serious problems related to dealing with a chemosensory disorder, psycho-social counselling may be considered.

[Oral medicine 4. Clinical aspects and treatment of taste and smell disorders]. / Oral medicine 4. Klinische aspecten, gevolgen en behandeling van smaak- en reukstoornissen.

Taste and smell perception are closely related. Many chemosensory disorders which result in faulty taste are in fact smell disorders. Causes ofchemosensory disorders which call for attention are ageing, medication, natural proteins, burning mouth syndrome, nerve injuries, aerate disorders in the neighbourhood of the sense ofsmell, damage to the smell epithelium, and oncologic diseases or their treatment. A chemosensory disorder has implications for food delight and psychological well-being, may lead to weight loss or increase and to deficient intake of vitamins and minerals. A chemosensory disorder can be treated by medication, surgical intervention, improvement of oral health, smell rehabilitation, and dietary advice.

[Oral medicine 3. Anatomy, physiology and diagnostic considerations of taste and smell disorders]. / Oral medicine 3. Anatomie, fysiologie en diagnostische overwegingen bij smaak- en reukstoornissen.

Taste and smell perception are closely related. The taste perception is performed by taste buds which can distinguish salt, sour, sweet, bitter, and umami. Moreover, 2,000-4,000 smells can be recognized. Many taste disorders are in fact smell disorders. Saliva affects taste perception because it serves as a solvent for taste substances and as a protecting agent for the taste receptors. Therefore, hyposalivation leads to a reduction in taste perception, in which the concentration of zinc ions and specific proteins in saliva play an important role. In addition, zinc and iron deficiencies may cause diminished taste and smell perception.

Rhino-sinusitis related to endosseous implants extending into the nasal cavity. A case report.

Rhino-sinusitis may develop as a result of an altered airflow in the nasal cavity causing irritation of the nasal mucosa. A patient is presented who developed recurrent rhino-sinusitis complaints following placement of endosseous implants in the maxilla. Inspection of the nasal floor revealed that two implants had perforated the floor of the nasal cavity. The part of the implants protruding in the nasal cavity was surgically resected via an endonasal approach whereupon the rhino-sinusitis complaints disappeared.

Influence of the Provox Flush, blowing and imitated coughing on voice prosthetic biofilms in vitro.

OBJECTIVE: This study investigates the effect of regular airflow, as an isolated single factor, through Groningen and Provox2 voice prostheses on biofilm formation. MATERIAL AND METHODS: Groningen and Provox2 voice prostheses were placed in a modified Robbins device and inoculated with the total microflora from an explanted Groningen voice prosthesis. After 3 days, prostheses were either flushed 3 times per day with the Provox flush, treated with an airflow using an increasing order of air pressure (10, 15 and 20 cmH2O) or vigorously perfused by means of imitated coughing (air pressure 20 cmH2O). As a control, prostheses were left undisturbed to promote biofilm growth. Following flushing, blowing or coughing, each artificial throat was perfused with 200 ml of phosphate-buffered saline. This procedure was repeated three times a day for 9 days. At the end of each day, the artificial throats were filled with growth medium for 30 min and left empty during the night after draining. After 12 days the microflora on each voice prosthesis was quantified by plating on blood agar for bacteria and on de Man, Rogosa and Sharpe agar for yeasts. RESULTS: The use of the Provox flush reduced bacterial prevalence on Groningen and Provox2 voice prostheses to 71% and 45% of the control values, respectively, without affecting the number of yeasts. Increasing airflows and imitated coughing yielded reductions of 45-70% in bacterial and yeast prevalence on Provox2 voice prostheses. On the Groningen voice prostheses the effects of increasing airflows and imitated coughing were less pronounced: reductions in bacterial and yeast prevalence of 56-87% were observed. CONCLUSION: This study shows that use of the Provox flush has a cleansing effect, especially on Provox2 voice prostheses, and furthermore suggests that daily airflow through voice prostheses as part of a daily maintenance scheme reduces biofilm formation and can be expected to prolong the life of these devices.

Biofilm formation on voice prostheses: in vitro influence of probiotics.

In order to determine the influence of probiotic bacteria on biofilm formation on Groningen and Provox 2 voice prostheses in an artificial throat, we grew biofilms on both types of voice prostheses and exposed them 3 times daily to a probiotic bacterial suspension. As a control, we perfused an artificial throat with phosphate-buffered saline solution. Perfusion with Lactococcus lactis 53 suspension reduced the percentage numbers of bacteria and yeasts, respectively, on the Groningen prostheses to 17% and 22% and on the Provox 2 prostheses to 19% and 45%, compared to the number of colony-forming units on the control prosthesis, which was set at 100%. A suspension of Streptococcus thermophilus B reduced the percentage numbers of bacteria and yeasts, respectively, on the Groningen prostheses to 53% and 33% and on the Provox 2 prostheses to 14% and 0%, as compared to the control prosthesis. All other probiotic strains tested caused some reduction in the percentages of bacteria or yeasts, but strong differences between the types of prostheses were observed. In conclusion, L. lactis 53 and S. thermophilus B strongly reduce the occurrence of yeasts and bacteria in voice prosthetic biofilms.

Biofilm formation and design features of indwelling silicone rubber tracheoesophageal voice prostheses--an electron microscopical study.

After total laryngectomy, voice can be restored with a silicone rubber tracheoesophageal voice prosthesis. However, biofilm formation and subsequent deterioration of the silicone material of the prosthesis will limit device life by impairing valve function. To simulate the natural process of biofilm development under dynamic nutrient conditions, a modified Robbins device was used to evaluate the biofilm-related valve dysfunction of the Groningen, Provox2, Blom-Singer indwelling, and VoiceMaster voice prostheses. Obstruction of the semicircular slit-valved Groningen prosthesis leading to increased airway resistance was caused not only by a buildup of deposits on the esophageal flange and valve hat, but also by accumulation of deposits on the semicircular valve seating. The hinged flap valved Provox2 and indwelling Blom-Singer prostheses failed to close sufficiently because of biofilm formation on the valve seating. The esophageal flange of the VoiceMaster prosthesis was affected, but the tripod structure of the ball valve was fully colonized up to the titanium sleeve, which interfered with proper valve opening and closure. These findings on biofilm formation could be used for the further development and modification of critical design features of voice prostheses to facilitate tracheoesophageal speech.

[Disorders of taste and smell]. / Smaak- en reukstoornissen.

Disorders of taste and smell not only are uncomfortable to the person involved, e.g. because of an impaired hedonic and sensory experience of food or the continuous presence of a nasty taste, but can also result in loss of body weight and may have a negative influence on the quality of life. In this article both the physiology of chemosensory function and dysfunction of taste and smell are discussed as well as some clinical consequences and their treatment.

Air-flow resistances of silicone rubber voice prostheses after formation of bacterial and fungal biofilms.

Laryngectomized patients use silicone rubber voice prostheses to rehabilitate their voice. However, biofilm formation limits the lifetime of voice prostheses by causing leakage or an increased air-flow resistance and the prosthesis has to be replaced. To determine which bacterial or yeast strains, isolated from explanted voice prostheses, contribute most to increases in air-flow resistance of silicone rubber voice prostheses, biofilms consisting of either a bacterial or a yeast strain were grown on voice prostheses in the artificial throat model. The effects of these biofilms on air-flow resistances were determined by calculating the difference in air-flow resistance of the individual voice prosthesis as covered with a 7-day-old biofilm with the situation prior to biofilm formation. Conspicuously, voice prosthetic biofilms formed by the bacterial strains Staphylococcus aureus GB 2/1 and Rothia dentocariosa GBJ 41/25B and their excreted organic matter showed larger increases in air-flow resistance (more then 30 cm H(2)O.s/L) than biofilms formed by Candida species. This is contrary to the literature, where there seems to be agreement that Candida species are mainly responsible for clinical failure of silicone rubber voice prostheses.

Effect of probiotic bacteria on prevalence of yeasts in oropharyngeal biofilms on silicone rubber voice prostheses in vitro.

The proliferation of yeasts in the mixed bacterial and fungal biofilms colonising silicone rubber voice prostheses in laryngectomised patients is the main cause of malfunctioning of the valve mechanism on the oesophageal side of the prostheses. Indwelling voice prostheses usually have to be replaced every 3-4 months. The consumption of probiotic bacteria is largely motivated by health claims related to the urogenital and lower digestive tract, but not to the upper digestive tract. The present study examined the influence of probiotic bacteria on the prevalence of yeasts in oropharyngeal biofilms on silicone rubber voice prostheses, as formed in a modified Robbins device. Exposure of oropharyngeal biofilms on voice prostheses to suspensions of Bifidobacterium infantis 420 or Enterococcus faecium 603 did not significantly reduce the number of yeasts in the biofilm. However, suspensions of Lactobacillus fermentum B54, L. rhamnosus 744 or L. lactis cremoris SK11 led to a reduction in the number of yeasts harvested from the voice prostheses. Suspensions of L. casei Shirota and Streptococcus thermophilus B significantly reduced the number of yeasts in the biofilm to 39% and 33%, respectively. The reduction brought about in yeast prevalence in the mixed biofilm was greatest by exposure to a suspension of L. lactis 53, with yeast prevalence only 4% of the control. In conclusion, the study demonstrated that the prevalence of yeasts in oropharyngeal biofilms on silicone rubber voice prostheses might be controlled by consumption of probiotic bacteria.

Preliminary observations on influence of dairy products on biofilm removal from silicone rubber voice prostheses in vitro.

We determined oropharyngeal biofilm removal from silicone rubber voice prostheses in an artificial throat after perfusion with different commercially available dairy products, including buttermilk, Lactobacillus casei Shirota fermented milk (Yakult, Yakult Netherlands BV, Almere, The Netherlands), low-fat milk, and three types of yogurt. Buttermilk removed both yeasts and bacteria from biofilms on voice prostheses, but this was not observed with a pasteurized buttermilk product. Some of the other products, most notably Yakult fermented milk drink, reduced the number of bacteria, whereas growth of yeasts in the biofilms was not inhibited. This study demonstrates that there may be health benefits associated with the consumption of certain dairy products when applied to the upper digestive tract.

Biofilm formation on voice prostheses: influence of dairy products in vitro.

Laryngectomized patients use silicone rubber voice prostheses to regain their speech, however, the lifetime of these devices is limited due to biofilm formation. Following anecdotal evidence, the influence of various dairy products on biofilm formation on voice prostheses was studied, using the artificial throat-model. Biofilms were grown on Groningen and Provox2 voice prostheses by inoculating two artificial throats with the total microflora isolated from an explanted Groningen voice prosthesis. After 3 days, one throat was perfused three times daily with 650 ml dairy product; the other was perfused with phosphate buffered saline, used as a control. After 12 days the microflora on each voice prosthesis was determined. Perfusion of the artificial throat with buttermilk three times daily for 9 days reduced the amount of bacteria and yeasts in the biofilm on Groningen voice prostheses to 3% and 15% of the control, respectively. These effects were not observed with a pasteurized conservable buttermilk product. Yakult fermented milk drink, Mona mild yoghurt, Mona vifit yoghurt, semi-skimmed milk and low-fat yoghurt reduced the amount of bacteria by various degrees, ranging from 12% (Yakult) to 88% (Mona mild) of the control, but these products did not inhibit, and sometimes even stimulated, yeast growth. A combination of buttermilk and Yakult did not show a synergistic effect, as expected. Effects for the Provox2 voice prosthesis were less pronounced. These in vitro experiments in the artificial throat demonstrated that the formation of the biofilm on voice prostheses can be lessened by the daily use of certain dairy products, of which buttermilk had the strongest inhibitory effect, followed by Yakult.

Cineradiography of the pharyngoesophageal segment in postlaryngectomy patients.

The use of tracheoesophageal voice prostheses has gained wide acceptance in the field of vocal rehabilitation after total laryngectomy. In a randomized study with 3 arms, alaryngeal speech proficiency was assessed in 60 postlaryngectomy patients: 20 patients underwent primary unilateral pharyngeal myotomy, 21 patients underwent neurectomy of the pharyngeal plexus in addition to pharyngeal myotomy, and 19 patients did not undergo an additional surgical procedure. Pharyngoesophageal (PE) dynamics were examined during esophageal and tracheoesophageal speech. A single vibrating PE segment was seen in good alaryngeal speakers. Hypertonicity, spasm, strictures, and hypotonicity of the PE segment were correlated significantly with poor or moderate alaryngeal speech. Unilateral myotomy with or without unilateral neurectomy prevented hypertonicity or spasm of the PE segment. The acquisition of alaryngeal speech did not differ significantly between the 2 groups who had undergone an additional surgical procedure. Evaluation of anatomic and physiological factors may be helpful in subsequent clinical management to achieve effective alaryngeal speech.

Antimicrobial activity of synthetic salivary peptides against voice prosthetic microorganisms.

OBJECTIVES: To investigate whether synthetic salivary antimicrobial peptides have an inhibitory effect on the growth of bacteria and yeasts isolated from used silicone rubber voice prostheses. METHODS: The antimicrobial activities of six synthetic salivary peptides (histatin 5, dhvarl, dhvar4, dhvar5, lactoferrin b 1730 [LFb 17-30], and cystatin S1-15) at concentrations of 2 and 4 mg/mL were determined against different oropharyngeal yeast (four) and bacterial (eight) strains and against a "total microflora" isolated from explanted voice prostheses using agar diffusion tests. The spectrum of susceptible microorganisms was determined qualitatively. RESULTS: Histatin 5 and cystatin S1-15 did not show any antimicrobial activity against the microorganisms involved in this study. Dhvar1 was active against some of the oropharyngeal microorganisms tested, including the yeast strains, but not against Rothia dentocariosa, Staphylococcus aureus, Escherichia coli, and the total microflora Dhvar4 was active against all microorganisms tested, including the total microflora. Dhvar5 lacked activity against E coli and the total microflora LFb 1730 did not inhibit the growth of any of the yeast strains involved and showed only minor activity against some of the bacterial strains. LFb 1730 slightly inhibited the growth of the total microflora from an explanted prosthesis. CONCLUSIONS: The synthetic salivary peptide dhvar4 has a broad antimicrobial activity against all microorganisms that are commonly isolated from explanted voice prostheses, including yeasts. Therewith, it may represent a useful drug, as an alternative for antibiotics and antimycotics employed in various ways to prolong the lifetime of voice prostheses in laryngectomees.

[Interface between dentistry and otorhinolaryngology]. / Raakvlakken tussen tandheelkunde en KNO-heelkunde.

In this paper some relevant pathological aspects on the interface of dentistry and ENT surgery are discussed. A major part of the field of ENT surgery is not available for direct inspection and/or evaluation. Therefore, ENT pathology is often overseen or not detected at an early stage. Because of frequent patient-dentist contact, also in healthy patients, dentists can play an important role in early detection of ENT pathology. The combination of specific anatomic knowledge of the ENT region and a proper anamnesis are potent tools for a dentist to suspect ENT pathology, even in not easily accessible areas like the hypopharynx and oesophagus.

The artificial throat: a new method for standardization of in vitro experiments with tracheo-oesophageal voice prostheses.

After total laryngectomy, the voice can be restored successfully with a silicone tracheo-oesophageal voice prosthesis. Biofilm formation and subsequent deterioration of the silicone material of the prosthesis often limit the mean life of the device to an average of 3-5 months. Although device replacement can be considered an easy outpatient procedure, frequent replacements are inconvenient for the patient and may lead to malfunction of the tracheo-oesophageal fistula. Further understanding of the process of development and inhibition of the colonization of these polymer surfaces requires several comprehensive clinical studies. However, in vivo research of the biomaterials of the voice prostheses is difficult and time consuming. In order to simulate the natural process of biofilm development under dynamic nutrient conditions, an artificial throat was developed. Biofilm developed on Groningen button voice prostheses in vitro could not be distinguished from that formed over several months in vivo. This method can be used as a standardized approach for studying functional and structural aspects of all commercially available indwelling and non-indwelling voice prostheses, including the Groningen button, Provox, Voice Master, Blom-Singer and others under various laboratory conditions.

The effect of buttermilk consumption on biofilm formation on silicone rubber voice prostheses in an artificial throat.

Biofilm formation on indwelling silicone rubber voice prostheses in laryngectomized patients is still the main reason for dysfunction of the valve, leading to frequent replacements. Within patient support groups in The Netherlands, laryngectomees have suggested that the consumption of buttermilk prolongs the life-time of indwelling silicone rubber voice prostheses. The aim of the present study was to compare biofilm formation on Groningen button voice prostheses in a so-called artificial throat. Ten prostheses were placed in a simulated control group and ten other prostheses in a group with a simulated consumption of 700 ml buttermilk three times a day. Biofilms were allowed to grow on the prostheses by inoculating two artificial throats with the total cultivable microflora (bacteria and yeasts) isolated from an explanted Groningen button voice prosthesis. After 3 days, one artificial throat was perfused three times daily with phosphate buffer (control group) for 8 days, while the other artificial throat was perfused with buttermilk. Prostheses removed from the artificial throat in the control group were covered with a thick biofilm. Scanning electron microscopy showed microcolonies growing into the silicone rubber, similar to the ingrowth observed on explanted Groningen buttons. The simulated consumption of buttermilk in the other artificial throat almost fully prevented the formation of a biofilm on the prostheses during the experimental period. These in vitro experiments in the artificial throat demonstrate that the deterioration of voice prostheses can be lessened by the daily intake of buttermilk through its inhibitory effects on biofilm formation.

Interactions between inhalant allergen extracts and airway epithelial cells: effect on cytokine production and cell detachment.

BACKGROUND: The factors responsible for inducing or maintaining airway inflammation are poorly understood. Various studies have focussed on the mechanisms leading to allergic airway inflammation in patients with asthma and rhinitis. The observation of local airway inflammation in nonallergic patients with asthma or rhinitis, including those with nasal polyposis, suggest that non-IgE-related mechanisms exist that may lead to airway inflammation. Various lines of evidence suggest that epithelial cells may participate in local inflammation of the airways. OBJECTIVE: This study focused on the interaction of airway epithelial cells with clinically relevant inhalant allergen extracts in vitro. METHODS: Cultures of airway epithelial cells were exposed to mite, Timothy grass pollen, and birch pollen extracts. Production of IL-8, IL-6, monocyte-chemotactic protein-1 (MCP-1), and granulocyte-macrophage colony-stimulating factor and cell detachment were monitored while protease inhibitors and chromatography techniques were applied to identify the factors responsible for these effects. RESULTS: With the mite extracts, cytokine production and cell detachment was largely dependent on protease activity. With the pollen extracts, cytokine production without cell detachment seemed to be independent of protease activity. CONCLUSION: These findings support the view that epithelial cells may contribute to the pathogenesis of airway disease by their interaction with inhalant allergen extracts. Furthermore, allergen extracts may enhance airway inflammation by means other than their IgE-binding activity through both protease-dependent and protease-independent mechanisms.