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choice. The XtraStrong version is seldom required. The insusceptibility of the fluoroplastic material the valve mechanism is constructed of recently could be demonstrated, as shown in the figure below.28 15. Hilgers FJ, Ackerstaff AH, Balm AJ, Van den Brekel MW, Bing Tan I, Persson JO. A new problem- solving indwelling voice prosthesis, eliminating the need for frequent Candida- and underpressure- related replacements: Provox ActiValve. Acta Otolaryngol 2003; 123:972-979. 16. Graville DJ, Palmer AD, Andersen PE, Cohen JI. Determining the efficacy and cost-effectiveness of the ActiValve: results of a long-term prospective trial. Laryngoscope 2011; 121:769-776. 17. Soolsma J, van den Brekel MW, Ackerstaff AH, Balm AJ, Tan B, Hilgers FJ. Long-term results of Provox ActiValve, solving the problem of frequent candida- and underpressure-related voice prosthesis replacements. Laryngoscope 2008; 118:252-257. 18. Kress P , Schafer P , Schwerdtfeger FP , Rosler S. Are modern voice prostheses better? A lifetime comparison of 749 voice prostheses. Eur Arch Otorhinolaryngol 2014; 271:133-140. 19. Timmermans AJ, Harmsen HJ, Bus-Spoor Cet al. Biofilm formation on the Provox ActiValve: Composition and ingrowth analyzed by Illumina paired-end RNA sequencing, fluorescence in situ hybridization, and confocal laser scanning microscopy. Head Neck 2015. 72