创伤性脑损伤后双侧声带麻痹的计算机辅助嗓音训练：26个月随访病例报告

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中文摘要

目的： 评估计算机辅助嗓音训练在一名创伤性脑损伤（TBI）后发生双侧声带麻痹（BVFP）患者中的长期疗效；该病症尚无标准化的非手术方案，且完全缺乏长期客观结局数据。
方法： 一名27岁女性，重度TBI后在气管造口拔管后出现BVFP，接受为期3个月的计算机辅助嗓音训练（每周5次，每次20分钟），通过视觉生物反馈针对最长发声时间和嗓音强度进行训练。采用发声障碍严重程度指数（DSI）、最长发声时间（MPT）、基频微扰（jitter）、振幅微扰（shimmer）和嗓音障碍指数-10（VHI-10）评估嗓音结局，并在6个月和26个月时随访。同时进行了纤维内镜吞咽评估（FEES）。
结果： DSI从基线的-22.28显著改善至26个月时的+0.73（提高23.01分）。MPT增加191%（从8.60秒增至25.02秒，超过正常参考值），jitter恢复正常至0.43%，VHI-10改善64.7%（从34降至12）。FEES显示声带内收改善，穿透-误吸量表从6改善至1。
结论： 本病例表明，计算机辅助嗓音训练可使TBI后BVFP获得显著且持续的改善，为这一罕见并发症提供了一种可行的非手术康复选择。26个月随访提供了该人群迄今报告的最长客观结局数据。

英文摘要

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.