Total laryngectomy is performed in advanced laryngeal and hypopharyngeal cancer stages and results in reduced quality of life due to the loss of voice and smell, permanent tracheostoma and occasionally dysphagia. Therefore, successful voice rehabilitation is highly beneficial for the patients' quality of life after surgery. Over the past decades, voice prostheses have evolved to the gold standard in rehabilitation and allow faster and superior voicing results after laryngectomy compared to esophageal speech. Polyspecies biofilm formation has become the limiting factor for device lifetimes and causes prosthesis dysfunction, leakage and in consequence pneumonia, if not replaced immediately. Although major improvements in prosthesis design have been made and scientific insight in the complexity of biofilm evolution and material interaction progresses, the microbial colonization continues to restrict device lifetimes, causing patient discomfort and elevated health costs. However, present scientific findings and advances in technology yield promising future approaches to improve the situation for laryngectomized patients.