Prediction of Aspiration Risk by Using Vocal Biomarkers: Machine Learning Development and Validation Study
Background: Aspiration causes or aggravates a variety of respiratory diseases. Subjective bedside evaluations of aspiration are limited by poor interrater and intrarater reliability, while gold standard diagnostic tests for aspiration, such as video fluoroscopic swallow study and fiberoptic endoscopic evaluation of swallowing, are cumbersome or invasive and health care resource-intensive. Objective: This study aims to develop and validate a novel machine learning (ML) algorithm that can analyze simple vowel phonations to aid in predicting aspiration risk. Methods: Recorded [i] phonations during routine nasal endoscopy from 163 unique patients were retrospectively analyzed for acoustic features, including pitch, jitter, shimmer, harmonic to noise ratio, and others. Supervised ML was performed on the vowel phonations of those at high-risk for aspiration versus those at low-risk for aspiration. Ground truth of aspiration risk classification for model development was established using a video fluoroscopic swallow study. The performance of the ML model was tested on an independent, external cohort of patient voice samples. The performance of trained speech language pathologists to categorize high versus low-risk aspirators by listening to phonations was compared against the ML model. Results: Mean ML risk score for those with the ground truth of high versus low aspiration risk was 0.530 (SD 0.310) vs 0.243 (SD 0.249), which was a significant difference (0.287, 95% CI 0.192-0.381; P
