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Needle electromyography (EMG) is the gold standard for electrodiagnostic testing, but it is invasive and relies on subjective interpretation of the EMG signal. This study explores the potential of non-invasive high-density surface electromyography (\n                      <jats:sub>HDS<\/jats:sub>\n                      EMG) to detect and quantify hypoglossal neuropathy in OPC survivors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      In an exploratory study, examine the feasibility of\n                      <jats:sub>HDS<\/jats:sub>\n                      EMG for rapid, non-invasive screening of hypoglossal nerve (CN XII) function and estimate the prevalence of hypoglossal neuropathy before and after oropharyngeal radiotherapy, and associate with patient-reported and clinician-graded functional outcomes. Machine learning performance will be measured through sensitivity, specificity, and F1 score, with a target area under the curve\u2009&gt;\u20090.7 based on literature-reported EMG sensitivity and specificity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This protocol will recruit patients aged\u2009\u2265\u200918 years who receive radiation therapy for OPC at MD Anderson Cancer Center (MDACC) between 2024\u20132025 and consent to experimental\n                      <jats:sub>HDS<\/jats:sub>\n                      EMG testing. Sanchez Research Lab (The University of Utah, Salt Lake City, UT) will perform data analysis. Clinical data\u2014including electrical impedance measurement (EIM), patient-reported outcomes, dysphagia grading, tongue functions, fibrosis grading, and needle EMG\u2014will be collected from n\u2009=\u200936 patients. Features extracted from\n                      <jats:sub>HDS<\/jats:sub>\n                      EMG will be correlated with other clinical outcomes and used to train a machine learning classifier to quantify the severity of hypoglossal neuropathy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0347891","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T17:43:37Z","timestamp":1777484617000},"page":"e0347891","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A cross-sectional protocol for experimental tongue high-density surface electromyography to detect and classify radiation-associated hypoglossal neuropathy"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8466-7520","authenticated-orcid":true,"given":"Nathan J.","family":"Hansen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Woodman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Peterson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila","family":"Buoy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohui","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shitong","family":"Mao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy C.","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen Y.","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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