Infected in-dwelling voice prostheses (Blom-Singer) Valves

Case Definition:

Usually a fungal infection/colonisation of the valve. Candida species are the commonest pathogens.


Diagnostic criteria:

Patients present with frequent valve failure, poor speech quality and valve incompetence leading to valve leakage and potential aspiration. Clinical inspection of the valve shows a grey/yellow colonisation on the valve surface.


Specimens to be collected:

  • Swab of valve for fungal culture

Other advice can be obtained from the speech and language therapy team who jointly manage these cases.


Group 1

2 – 4 exdwelling prostheses
2 indwelling prostheses

 Mild colonisation

Clean prosthesis daily

Exdwelling patients sterilize with 3% hydrogen peroxide (H2O2)

Group 2

6 – 8 exdwelling prostheses
3 indwelling prostheses


Moderate colonisation

Clean  prosthesis daily

Nystatin liquid 1ml QDS after food. The liquid should be rinsed around the mouth before swallowing.

In addition:
Exdwelling patients sterilize with 3% H2O2

Group 3

more than 8 exdwelling prostheses
4 – 6 indwelling prostheses 


High colonisation

Clean meticulously and sterilize regularly

Check for reflux oesophagitis and manage medically

Initially prescribe FLUCONAZOLE 50mg po od. Once under control reduce to a topical antifungal (i.e. nystatin liquid).

Last reviewed 23/04/14

 For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)