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Acoustic assessment of airway protective maneuvers and swallowing function in head and neck cancer patients with dysphagia

par Mootassim-Billah, Sofiana
Président du jury Langer, Ingrid
Promoteur Arvanitakis, Marianna ;Van Nuffelen, Gwen
Co-Promoteur Schoentgen, Jean ;De Bodt, Marc M.S.
Publication Non publié, 2025-02-20

Thèse de doctorat

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Résumé :

Radiation-associated dysphagia (RAD) is a prevalent condition among head and neck cancer patients following (chemo)radiotherapy, often resulting in impaired cough function due to muscle atrophy, fibrosis, and sensory deterioration. This weakened cough reflex increases the risk of aspiration and subsequent aspiration pneumonia. Despite the well-established role of cough efficacy in predicting aspiration risk, current clinical cough assessments are unreliable and unsuitable for routine practice, stressing the need for novel methods such as cough sound analysis to monitor dysphagia and aspiration risk (Chapter 2).To enhance the daily clinical evaluation of RAD, the ACCOUGH software was developed to assess airway protective maneuvers using temporal and spectral acoustic features. When used in conjunction with a validated throat microphone, the software enables objective assessment of coughing and throat clearing during a clinical swallowing evaluation (Chapter 3).To establish reference data, this research investigated the acoustic features of different airway protective maneuvers in a healthy population (Chapter 4). Temporal and spectral analyses revealed significant acoustic differences between voluntary coughs, voluntary throat clearings, and induced reflexive coughs, suggesting that each maneuver provides complementary information regarding airway protection.While voluntary cough and induced reflexive cough are well-documented predictors of airway clearance and aspiration risk, voluntary throat clearing remains poorly studied. To address this gap, an aerodynamic assessment was conducted to compare the airflow features of voluntary throat clearing with those of voluntary and reflexive coughs (Chapter 5). The findings demonstrated significant aerodynamic differences, confirming the physiological distinctiveness of throat clearing as an airway protective maneuver. The final study focused on the acoustic analysis of airway protective maneuvers in head and neck cancer patients with RAD (Chapter 6). The majority of patients exhibited penetration/aspiration, often silent and secondary to pharyngeal residue spillage. Acoustic features of voluntary throat clearing effectively distinguished between patients with and without penetration/aspiration, with high sensitivity and specificity. Furthermore, induced reflexive cough features successfully discriminated between patients and healthy controls.In conclusion, this doctoral thesis has enabled the development of acoustic features of different airway protective maneuvers as biomarkers for radiation-associated dysphagia in head and neck cancer patients.