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. 2025 Sep;47(9):2464-2485.
doi: 10.1002/hed.28163. Epub 2025 Apr 16.

Acoustic Features of Airway Protective Maneuvers as Biomarkers of Radiation-Associated Dysphagia and Penetration/Aspiration in Head and Neck Cancer Patients

Sofiana Mootassim-Billah  1 , Jean Schoentgen  2 , Marc De Bodt  3 , Hichem Slama  4 , Esther Willemse  5 , Tatiana Dragan  6 , Nicolas Roper  7 , Mathilde Le Tensorer  8 , Paulus Kristanto  9 , Marianne Paesmans  9 , Dirk Van Gestel  10 , Gwen Van Nuffelen  3
Affiliations

Acoustic Features of Airway Protective Maneuvers as Biomarkers of Radiation-Associated Dysphagia and Penetration/Aspiration in Head and Neck Cancer Patients

Sofiana Mootassim-Billah et al. Head Neck. 2025 Sep.

Abstract

Background: This study aimed at identifying acoustic features of airway protective maneuvers as biomarkers of radiation-associated dysphagia, involving penetration/aspiration and pharyngeal residue.

Methods: Temporal and spectral acoustical analyses were carried out on voluntary coughs, voluntary throat clearings, and reflexive coughs. Head and neck cancer patients with and without penetration/aspiration were compared. The same was done for patients and healthy controls.

Results: A decreased convexity of the amplitude contour and decreased salience of periodicity in the frequency band 0-400 Hz were observed in induced reflexive coughs of patients compared to healthy controls. A longer length and a less steep slope of the amplitude contour of voluntary throat clearings were observed in patients with penetration/aspiration versus those without.

Conclusions: Acoustic features of induced reflexive cough discriminate between patients and healthy controls, but do not relate to penetration/aspiration. However, acoustic features of voluntary throat clearing are associated with penetration/aspiration in head and neck cancer patients.

Keywords: acoustic features; airway protective maneuvers; head and neck cancer patients; penetration/aspiration; radiation‐associated dysphagia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(a) Example of a graph of the temporal analysis of a voluntary cough signal obtained with the ACCOUGH software. (b) Example of a graph of the spectral analysis of a voluntary cough signal obtained with the ACCOUGH software.
FIGURE 2
FIGURE 2
Head and neck cancer patient recruitment. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Receiver operator curves (ROC) for acoustic features of voluntary throat clearing that enabled distinguishing head and neck cancer patients with and without penetration/aspiration. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Length of voluntary throat clearings versus the slope of their amplitude contour in head and neck cancer patients with and without penetration/aspiration (z‐scores). Abbreviation: HNC = head and neck cancer; P/A = penetration/aspiration. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 5
FIGURE 5
K‐means clustering into 3 clusters based on the length of voluntary throat clearings and the slope of their amplitude contour in head and neck cancer patients with and without penetration/aspiration (z‐scores). Voluntary throat clearings (24/25) produced by patients without penetration/aspiration are assigned to cluster 1. Voluntary throat clearings produced by patients with penetration/aspiration are assigned to cluster 1 (49/125), cluster 2 (40/125) and cluster 3 (36/125). [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 6
FIGURE 6
Amplitude contour curvature and salience of periodicity in the frequency band 0–400 Hz of induced reflexive coughs of head and neck cancer patients versus healthy controls (z‐scores). Abbreviation: HNC = head and neck cancer. [Color figure can be viewed at wileyonlinelibrary.com]
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