Computer-assisted voice training for bilateral vocal fold paralysis following traumatic brain injury: a 26-month follow-up case report

Objective To evaluate the long-term efficacy of computer-assisted voice training in a patient with bilateral vocal fold paralysis (BVFP) following traumatic brain injury (TBI), a condition for which no standardized non-surgical protocol exists and long-term objective outcome data are entirely absent.Methods A 27-year-old female with severe TBI who developed BVFP after tracheostomy decannulation underwent 3 months of computer-assisted voice training (five sessions per week, 20 min per session) targeting maximum phonation time and vocal intensity via visual biofeedback. Voice outcomes were assessed using the Dysphonia Severity Index (DSI), maximum phonation time (MPT), jitter, shimmer, and the Voice Handicap Index-10 (VHI-10), with follow-ups at 6 and 26 months. Fiberoptic endoscopic evaluation of swallowing (FEES) was also performed.Results DSI improved dramatically from −22.28 at baseline to +0.73 at 26 months (a 23.01-point gain). MPT increased by 191% (from 8.60 s to 25.02 s, exceeding normative values), jitter normalized to 0.43%, and VHI-10 improved by 64.7% (from 34 to 12). FEES demonstrated improved vocal fold adduction with Penetration-Aspiration Scale improvement from 6 to 1.Conclusion This case demonstrates that computer-assisted voice training can produce significant and sustained improvements in post-TBI BVFP, offering a viable non-surgical rehabilitation option for this rare complication. The 26-month follow-up provides the longest objective outcome data reported for this population.