Possible Problems



yeast - do you have a problem?



If you wear the kind of prosthesis that you change yourself, you might be missing an opportunity to learn something by examining the one you are removing. After you take it out, do you toss it, drop it in some peroxide or other cleaning solution to re-use later, or do you take a good look at it in strong light? It can tell you a couple of things, especially if you leave your prosthesis inserted for long periods.

Some of us are told by our SLPs or doctors to change the prosthesis often, and right after the TEP surgery, it is wise to do so. If you have your puncture surgery while there is still swelling from the laryngectomy, it is even more wise to have frequent checkups. As the swelling goes down, the puncture often becomes shorter requiring a change in prosthesis length. Many of us go through reductions in size from something like 3.0 to 2.6 to 2.2 to 2.0 over a period of time. You might need the 3.0 for only 2 weeks, whereas, the change from 2.2 to 2.0 might take a year. The longer prosthesis will piston (move back and forth) in the shorter puncture causing leaks around the prosthesis and perhaps enlarging the diameter of the puncture, creating another problem. At first, a close watch is kept on the size and type (another subject altogether), to see if you need a change. Leaks and speech problems are indications that a change in length may be needed.

You may, after following whatever weekly or monthly change schedule that your therapist recommends, be able to wear your prosthesis for longer periods of time. However, if you have a yeast problem, you will have to change it more frequently as well as treat for the yeast. Leaks through the prosthesis are sometimes an indication that it is time to change. However, many people get nervous about a leak and will change it rather than take the time to clean it in place and be sure it is positioned correctly. We have discussed many times using the small intradental brush to clean the inside of the prosthesis and then flushing with one of several different tools. For those who can easily reach the prosthesis, you might use your finger or a long swab to be sure the prosthesis isn't tipped because of accidentally tugging on the strap, or perhaps putting a stoma vent in and moving the prosthesis to a different angle, again, accidentally. Sometimes, after doing all you can, just sleeping on it will tend to correct a leak overnight and you can postpone changing to another prosthesis for a while longer.

When it is time to put in a new one, remove the one you are using, lay it aside and proceed with your regular routine of inserting another prosthesis. Then, rinse the old one under the tap and look carefully at it, preferably in the sunlight. If you see little areas that look like yellow powder that has hardened, that is yeast. Check around the edges of the flange that holds the prosthesis in the esophagus and see if they are smooth. Sometimes the edge will feel rough and if you scrape away the roughness, the edge is no longer perfectly round. This is part of what yeast does. If you find any of this, wash the prosthesis with soap and water, drop it in a plastic bag, and take it with you the next time you see your SLP. If your appointment is a long time off, call to ask if you need medication for the yeast.

If you have a hardened scale around the outside of the shaft, you have probably left it in too long and need to change more frequently. If you have worn it a long time, there will likely be some stains at the esophageal end, but stains are not what you are looking for. The yeast and scale are the problems. So, next time you change it, take a good look and see what your prosthesis tells you.

Pat W Sanders, taken from HeadLines newsletter




There is a lot of talk about yeast and some of you might like to take this simple free at home test that you can do over anytime you are wondering how your yeast is doing...if you are wondering, it is probably thriving!
Might you have a problem with Candida Yeast?

You can try this simple test to find out.

1. First thing in the morning, before you put ANYTHING in your mouth, fill a clear glass with room temperature Bottled Water.

2. Work up a bit of saliva, then spit it into the glass of water.

3. Check the water every 15 minutes or so for up to one hour. If you have a potential problem, you will see strings (like legs) traveling down into the water from the saliva floating on the top, or "cloudy" saliva will sink to the bottom of the glass, or cloudy specks will seem to be suspended in the water. If there are no strings and the saliva is still floating after at least one hour, you probably have Candida under control, and have nothing to worry about. Congratulations!!

What can you do if the test shows positive?

Talk this over with your health care provider, as soon as possible.
Be aware that a Candida Yeast problem can be pretty difficult to deal with, especially after it has had enough time to get established and be causing you problems. It may not be easy, and it may take a while to impact the situation, be patient, and work on it everyday. Your good health is at stake.







from Mayo Clinic staff

Oral thrush and other candida infections can occur when your immune system is weakened by disease or drugs such as prednisone, or when antibiotics disturb the natural balance of microorganisms in your body.

Normally, your immune system works to repel harmful invading organisms, such as viruses, bacteria and fungi, while maintaining a balance between "good" and "bad" microbes that normally inhabit your body. But sometimes these protective mechanisms fail, which can allow an oral thrush infection to take hold.

Cancer is one of the illnesses that may make you more susceptible to oral thrush infection: your immune system is likely to be weakened both from the disease and from treatments such as chemotherapy and radiation, increasing your risk of candida infections such as oral thrush.

Diabetes mellitus. If you don't know you have diabetes or the disease isn't well controlled, your saliva may contain large amounts of sugar, which encourages the growth of candida.

If you have HIV, you may have especially severe symptoms in your mouth or esophagus, which can make eating painful and difficult. If the infection spreads to the intestines, it becomes difficult to receive adequate nutrition. In addition, thrush is more likely to spread to other parts of the body if you have cancer or other conditions that weaken the immune system. In that case, the areas most likely to be affected include the digestive tract, lungs and liver.

A list showing risk factors of why we with larynx or throat cancers are more susceptible to yeast:

Having a compromised immune system
Wearing dentures
Having other health conditions, such as diabetes or anemia
Taking certain medications, antibiotics, or corticosteroids, oral or inhaled
Undergoing chemotherapy or radiation treatment for cancer
Having conditions that cause dry mouth (xerostomia)


what to do about it


Comment on the use of these drugs for yeast, causing problems for laryngectomees... Reports from our members are: that most patients have been put on a Nystatin "swish for several minutes and swallow" routine for years.

Many of us have discovered that the yeast is normal but the problem is caused by overgrowth of yeast. This is often caused by taking an anti-biotic which killed the good bacteria in the system, leaving us with a chance for the hardy yeast bacteria to take over, sometimes causing symptoms throughout the intestinal tract as well  as overgrowth of yeast in the oral area.  This may be temporary and be treated for a few weeks, removing the problem.  It can be helped by diet changes and the addition of Pro-biotics/acidophilus supplements or eating foods such as yogurt daily.

However, many of us, especially those with a TEP have a prosthesis that extends into the esophagus area that creates an island for yeast to use as a home. Oral hygiene is extremely important and even forming habits like rinsing the mouth after eating can help to prevent the growth of excess yeast.

To educate yourself about the medications you may be looking at, I copied some information.

I have been on fluconazole for about 5 years, am still learning that carelessness about taking the pill, will see another bout of yeast on the prosthesis.

Pat Sanders

lary 1995

written 5-2013

This is only one site for checking meds but it is an excellent one. You can find more about each medication and what forms it has, liquid, powder, tablets to melt in your mouth, pills in various strengths.


What is the treatment for thrush?

Treatment of thrush depends on the cause and severity of the infection. If the thrush is caused by something that is reversible, such as taking antibiotics, smoking, ill-fitting dentures, or poorly controlled diabetes, these factors must be corrected as part of the treatment.

If an adult patient is diagnosed with a mild case of thrush, the doctor may prescribe an antifungal mouthwash (nystatin) or lozenges (clotrimazole [Mycelex]) for short-term use.

For more severe cases of thrush or if you have other reasons for a weakened immune system, you may need stronger systemic medications, such as fluconazole (Diflucan) or itraconazole (Sporanox).

GENERIC NAME: fluconazole
BRAND NAME: Diflucan
DRUG CLASS AND MECHANISM: Fluconazole is an anti-fungal medication related to clotrimazole (Lotrimin), ketoconazole (Nizoral), itraconazole(Sporanox), and miconazole (Micatin, Monistat). It prevents growth of fungi by preventing production of the membranes that surround fungal cells. The FDA approved fluconazole in January 1990.

GENERIC NAME: clotrimazole
BRAND NAME: Mycelex, Lotrimin-AF, Gyne-Lotrimin
DRUG CLASS AND MECHANISM: Clotrimazole is an anti-fungal medication related to fluconazole (Diflucan), ketoconazole (Nizoral),itraconazole (Sporanox), and miconazole (Micatin, Monistat). It prevents growth of several types of fungi by preventing interfering with the production of the membrane that surrounds fungal cells.

GENERIC NAME: itraconazole
BRAND NAME: Sporanox
DRUG CLASS AND MECHANISM: Itraconazole is an anti-fungal drug in the same class of drugs as fluconazole (Diflucan), ketoconazole (Nizoral), andmiconazole (Micatin, Monistat). It prevents growth of several types of fungi by preventing the fungi from producing the membranes that surround the fungal cells. The FDA approved itraconazole in September 1992.

BRAND NAME(S): Mycostatin, Nilstat, Nystex
USES: This medication is used to treat fungal infections of the mouth. Nystatin is an antifungal that works by stopping the growth of fungus.Nystatin suspension should not be used to treat fungal infections of the blood.

Are there home remedies for thrush?

Home remedies for thrush are aimed at decreasing risk factors for thrush as well as preventing overgrowth of the normally found Candida yeast.

• Brush your teeth with a soft toothbrush.
• Rinse your mouth with a diluted 3% hydrogen peroxide solution.
• Rinse your mouth with warm saltwater.
• Avoid mouthwash as it can alter the normal flora of your mouth.
• Keep your dentures clean and see a dentist if they do not fit correctly.
• Eat unsweetened yogurt if you are taking antibiotics.
• Lactobacillus acidophilus supplements may help maintain a healthy balance of Candida.



Yeast - Research and Reflection

It is not uncommon for us to have some amount of yeast, a fungus, in the digestive tract and it may not ever give us a cause for concern. It is when we have an overgrowth of yeast in comparison to the good bacteria that causes problems. Not a very technical explanation, but these do not “fight” each other. They live together but an overgrowth of yeast means it is taking up more room than it should and you don’t have room for the good bacteria you need.

Why do we, who have had throat cancer, talk about this yeast so much and why do so many TEP users especially, though not exclusively, take medication for it? Let’s have a look at who gets it, why some never notice, and what are some of the steps we can take to ease a yeast problem. Maybe we can help with ideas to keep it under control.

Who has yeast that multiplies too much? Many of us do at one time or another. The list of those who are at risk starts with babies, who sometimes get what is called thrush and have white patches in the mouth. A friend of mine had IMRT radiation treatment for his cancer and one of the worst everyday problems for him was thrush, an overgrowth of oral yeast. This is actually a fungal infection, which is temporary but requires treatment. In my friend’s case, it kept coming back with white patches, difficulty swallowing, and no appetite, until the treatments were over. Adults who wear dentures have some yeast and most likely will never know it. It may never bother them. People with immune system deficiencies or metabolic disorders, such as uncontrolled diabetes, RA, HIV, MS, or Crohn’s disease, are more susceptible to having yeast problems.

We have known for years that taking antibiotics can leave us with a yeast infection. Any immune suppressing drug may do the same. Other cancer treatments, such as chemo, can cause this side or after effect. It takes a change of this type in the body that favors the growth of yeast to make it noticeable. Some people have a burning sensation in the mouth and throat that might be caused by this fungus. Yeast can cause bad breath and bad taste, a raw and burning mouth, thickened saliva and, of course, it can colonize on a prosthesis even before the yeast overgrowth is bad enough to have these more obvious symptoms.

We, who wear prostheses, may have a problem with talking or leakage caused by the colonization of these yeast.. We know that the esophageal end of the prosthesis is exposed to whatever we swallow and if the yeast is in our saliva, the prosthesis is like an island in the stream where the yeast can get a foothold and colonize. Have you ever looked carefully at a prosthesis that has been removed? I thought it was important enough to write an article (March 2001 HeadLines) about how we need to examine the old prosthesis and I suggested you rinse the old one under the tap and look at it, preferably in the sunlight or very good lighting. I have even soaked one in peroxide first to remove stains (coffee can leave it looking brown), If you see little areas around the flange that look like yellow powder that has hardened, that is yeast. You may have to use a magnifying glass. Check around the edge of the flange that holds the prosthesis in the esophagus and see if it is smooth. Sometimes the edge will feel rough and if you scrape away the roughness, the edge is no longer perfectly round. This is part of what yeast does. You can’t scrub or brush this away after a deposit is there. This may look ugly but the yeast you see on the flange is not the part that will make that prosthesis leak through the middle. That will be deposits around the area on a “Low Pressure” where the valve (flap) of the prosthesis closes. Using a brush several times a day and running it barely through the valve opening twisting it slightly as you go may clean the yeast off of that area before it hardens and is like a barnacle on a ship’s hull. There are new yeast resistant prostheses that may help your problem with yeast deposits on your prosthesis but it wouldn’t hurt to try to reduce the amount that is knocking at the door of your low pressure one!

What can we do about it. In addition to the antifungal medications, any underlying conditions or causes need to be brought under control. If you are undergoing chemo, or on prolonged antibiotics, it is likely that you will be better after treatment is concluded. However, it is also likely that it will take medication to help get you back to the point where your natural body chemistry and defenses will take care of leveling off the yeast numbers as opposed to the good bacteria who want to live there, too. After taking antibiotics, a short course of treatment for yeast may be all you will need. One of the medications is one pill. That is not one-a-day; it is one pill, … of Diflucan. That might be all it takes for some to get back to normal. For people who have really bad cases, some doctors give it for a longer period, 3 weeks or so, but it can have side effects and many doctors prefer not to use it at all if Nystatin to swish or Mycelex troches will work. However, from a patient’s point of view, if one Diflucan pill after a round of antibiotics will stop a vaginal yeast infection in its tracks, then chances are it will work for oral yeast in a mild case. If it doesn’t, some doctors are prescribing it in other quantities. Once you control the immediate problem, there may be some ways to avoid prolonging these fungus infections or getting another.

Nutrition is always very important. Eat foods with fiber and plenty of vegetables. Stay away from excess sugar and fat. Getting and keeping your body in shape puts you a step ahead. If you are diabetic, control it so the high sugar in the saliva isn’t feeding the yeast. Replace or repair your dentures if they are leaving raw places.

This is how you start. If you are able to improve your health or immune system by taking better care of yourself, then you are not as likely to have an overgrowth of yeast and add to your problems. Now, don’t laugh, but people who exercise tend to have better body functions and are, in general, healthier. Drink your full quota of water. I have heard good comments made about deep breathing. None of these suggestions will hurt you. If they don’t help the yeast situation, they will help you to feel better and let your body naturally fight for you to be in good health.

Is there something you can add to your diet to help achieve the balance you need to keep the yeast from overpopulating? Yes. Acidophilus. Yogurt with live culture is the best known of the foods that will add this. It is a food that will help to add the good bacteria we have been talking about. You can take powdered acidophilus in a capsule but it is a tasteless powder so you can open a capsule, add it to food or liquid, even your daily yogurt and get some more goodies in your gut!

Daily oral cleaning habits can be improved and here are some suggestions that may help. Your mouth may be sensitive so you need a soft toothbrush and you might want a Water Pic to rinse your mouth often, using the most gentle setting. If you are doing regular cleaning, you can use a slightly stronger water pulse but don’t turn it on full blast because that could damage your gums. This is a very good way to clean in between your teeth and to rinse thoroughly before and/or after brushing. I also suggest you consider something like a Sonicare. It is gentle and effective for cleaning.

It might be a good idea to spend a few minutes getting your mouth very clean after you have eaten for the last time at night. That way, you are spending the longest period of the 24 hours each day with no food in your mouth and nothing to encourage the yeast.

Yeast will stay on fabric and then reactivate so it might pay to wash your stoma covers and washcloths in hot water. If yeast forms and grows in the mouth, it is likely that your tooth brush could have yeast on it along with other germs, so how do you make sure your toothbrush is clean. Putting yeast back in your mouth or through your prosthesis with those brushes and cleaning tools doesn’t seem like a very good idea to me so what will kill the yeast on these?

You can kill some germs by soaking in peroxide, mouthwash, or a combination. But, it appears those things don’t kill yeast. What does? Hot water over 122 degrees. Hot water heaters set at 125 would never get it to the faucet at near what you would need.. Rinsing equipment under the hot water faucet is not enough. Setting the temperature very high is a bit dangerous and why heat 40 or 50 gallons when you don’t need much? The dishwasher has extra heat so things you put in there would get the kind of heat you want. However, how about using a Pyrex measuring cup with a handle and putting in it all of the items you want to clean with hot water. Heat some water in the microwave or in a teakettle and pour the very hot (not boiling…that is 212F) water over all the equipment you use to clean your stoma and prosthesis. The small brushes, the tweezers. Let them cool in the water and then put them back to use the next time.

I have wondered about drinking hot drinks like coffee or tea Since the serving temp of coffee or tea is usually 155 to 165, there is a possibility that a few yeast might succumb as you sip the hot drink but if it doesn’t help kill yeast, it at least will make you feel better!

I hope you have learned a little bit about yeast and will understand that sometimes medicine alone isn’t enough. You have a responsibility for self-care. These suggestions are not cures but can let the medicine work better and can possibly stop the next overgrowth before it starts.

Some of the sites researched on Yeast



Topical treatment (active only on the area where applied) is generally the first choice for oral candidiasis and usually works for mild-to-moderate cases. Topical treatments for oral candidiasis include lozenges (also called troches) and mouth rinses.

One or two lozenges are taken for oral symptoms three to five times a day. They should be sucked slowly and not chewed or swallowed whole. Common brands are clotrimazole (Mycelex) and nystatin (Mycostatin).

Mouth rinses are generally less effective than lozenges since they are only in contact with the mouth for a short time. However, they may be the best choice for someone who has a very sore and dry mouth. Rinses are taken in between meals, in a measured amount and are held in the mouth for as long as possible. They should be swilled around in the mouth, then swallowed. They are used at least four times a day and should be continued for a few days after the symptoms have gone (generally two weeks). The most widely used rinse is nystatin (Mycostatin).

Systemic treatment (treatments that work throughout the body) are used for recurring candidiasis or outbreaks that do not clear up with topical treatment. They are also used for esophageal candidiasis.

Three anti-fungal drugs are approved for use in treating oral and esophageal candidiasis. They include ketoconazole (Nizoral), fluconazole (Diflucan) and itraconazole (Sporanox). Generally, doctors will start out with less aggressive therapies (like ketoconazole or itraconazole) and save the more potent fluconazole for later use, if necessary. If candidiasis does not improve with these drugs (i.e. becomes “azole” resistant), another drug, called amphotericin B (Fungizone) is often tried.

The dose of fluconazole is 200mg once a day for oral and esophageal candidiasis. Treatment typically lasts two weeks for oral candidiasis and three weeks for esophageal infection (or two weeks after symptoms clear up, whichever is longer).

Itraconazole is usually taken at a dose of 100mg once a day for oral candidiasis for one-to-two weeks and 200mg once a day for esophageal candidiasis for two to three weeks. It should also be taken with food. Itraconazole oral solution gives higher levels of the drug in the blood than the capsule and has been shown to be more effective. There is a greater potential for interactions between itraconazole and many anti-HIV therapies. For more information on drug interactions, call Project Inform’s Infoline and ask for Drug Interactions.

Ketoconazole (Nizoral) is usually taken at a dose of 200mg once a day for oral candidiasis for one-to-two weeks and 400mg once a day for esophageal candidiasis for two-to-three weeks. It should be taken with food. It may not be well absorbed in people with gut problems or who cannot eat very much. Taking it with an acidic drink (such as cola) may help.

Amphotericin B (Fungizone) is administered by an oral solution (100mg a day four times daily) or through intravenous injection (generally .5mg/kg a day) for two to three weeks. Newer liposomal versions of the drug, such as amphotericin B lipid complex (Abelcet), is administered by intravenous injection at a rate of 5mg/kg a day for two to three weeks

Pat Sanders - taken from HeadLines newsletter.




comments from members



1.  I just got back from my semi-annual visit with Dr. Blom to have my in-dwelling prosthesis changed. As he gave me my new prescription for Nystatin, he also gave me some new advice, which I think merits passing on. If you have a yeast problem that you treat with Nystatin and have to take antibiotics, do two things: 1. Double the time you swish the Nystatin in your mouth. This means go from a minimum of 5 minutes to a minimum of 10 minutes. Use a clock, minutes take longer to pass than you think. 2. Use the Nystatin swish 3 times a day rather than 2 times a day.

Antibiotics favor the growth of yeast. Therefore, the upping of the Nystatin when taking antibiotics is advised. Also, remember, if you have your own teeth, wait at least 5 minutes then brush your teeth after swishing with nystatin. This will remove the sugar in the nystatin from your teeth.

(Terry G Duga)

2.  After I swish a few drops of Nystatin once daily for several minutes and then swallow it, I put a few drops on my prosthesis brush and run it into my Provox 2 daily to kill the yeast. If you are using the InHealth indwelling instead of the Provox 2, you can dilute the Nystatin with a bit of water and use the pipette to squirt it into your prosthesis instead.

(Sydney Gartenberg)




1. I too had a very bad yeast problem. My prosthesis is Provox NID (patient changeable) and I could not get more than about three weeks out of it. Then I went on over the counter Acidophilus, 2 Billion livies/day, cost less than twenty cents per day and now I average about four months per prosthesis.

It is available at Walmart and other pharmacies -- be sure and get the 2 Billion/tablet or capsule. You will likely see improvement within four to six weeks but it will take several months to attain full benefit.

I spoke with my SLP about this product/treatment as to why this product was not recommended by the medical community. He acknowledged that he was welll aware of the many laryngectomees that had solved their yeast problem with it, but because no approved studies had been conducted and all reports were considered "ancedotal" most medicos would not consider it. (Dave in Florida)

2.  My last indwelling lasted 10 months and was replace because of size not yeast. Just before I got that one, I started to fight the yeast problem with a good probiotic Acidophilus I get at the health food store. Jarro is the brand and it is refrigerated. I take a couple every morning before I eat. Probiotics help keep your body in good balance in regard to yeast. Yeast usually starts in your month so I brush my teeth first thing when I wake up.
If you have taken antibiotics it is important to replace the good bugs
that are killed so the yeast doesn't take over.

I just don't think it is a good idea to swallow a big gulp of Nystatin an
anti-fungal med every day for years. I do dip my cleaning brush in it and swish it in my TEP twice a day. The TEP I have in now has been in for over 6 months and no sign of yeast. A small bottle of nystatin used the way I use it will last a couple years and should only cost around $30.00






How do antibiotics work for us, as laryngectomees, especially prosthesis users? Antibiotics do not damage the prosthesis but they kill off the good bacteria, some of which keep yeast under control. With yeast being released from the good bacteria guarding it, it can run rampant, and THAT is what causes the prosthesis problems. With lots of yeast in the area of the esophagus, they find the esophageal end of the prosthesis and colonize. Those who do not have a prosthesis, can still have yeast (and even thrush) from the yeast but the prosthesis user has the problem of leakage and replacement.

Can you stop this? You can ease it. Talk to your doctor and there are several medications that help this, such as Nystatin and fluconazole. But as a regular help to avoid the problem, eat yogurt because it replaces good bacteria. When you take the antibiotic, it will still kill the good with the bad, but replacement of the acidophilus helps.

I also believe that brushing and flushing your prosthesis regularly helps and getting your teeth and mouth brushed and rinsed regularly also helps, especially at night. Gargle a bit if you can even with plain water. All of this removes some of the feeding ground for the yeast.

Please read this for a more technical explanation:


Some antibiotics, such as the penicillins, are 'bactericidal', meaning that they work by killing bacteria. They do this by interfering with the formation of the cell walls or cell contents of the bacteria. Other antibiotics are 'bacteriostatic', meaning that they work by stopping bacteria multiplying.

Antibiotics are usually used to treat infections caused by bacteria. They do not work against other organisms such as fungi or infectious agents such as viruses. It's important to bear this in mind if you think you have some sort of infection, because many common illnesses, particularly of the upper respiratory tract such as the common cold and sore throats, are usually caused by viruses. Overuse of antibiotics can lead to bacteria becoming resistant to them so it's important to only take them when necessary. (See this page).

Some antibiotics can be used to treat a wide range of infections and are known as 'broad-spectrum' antibiotics. Others are only effective against a few types of bacteria and are called 'narrow-spectrum' antibiotics. Some antibiotics work against aerobic bacteria, that is organisms that need oxygen to live, while others work against anaerobic bacteria, organisms that don't need oxygen. Sometimes antibiotics are given to prevent an infection occurring, for example, before certain operations. This is known as prophylactic use of antibiotics and is common before orthopaedic and bowel surgery.

The most common side effects with antibiotic drugs are diarrhea, feeling sick and being sick. Fungal infections of the mouth, digestive tract and vagina can also occur with antibiotics because they destroy the protective 'good' bacteria in the body (which help prevent overgrowth of any one organism), as well as the 'bad' ones, responsible for the infection being treated.





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