The "Brain Stethoscope": A Non-Invasive Method for Detecting Elevated Intracranial Pressure

Introduction Minimally invasive intracranial pressure (ICP) screening has long been desired by neurosurgeons. A novel approach deriving ICP from tympanic membrane (TM) pulsation may offer the solution. The ICP waveform appears to be transmitted to the TM by the cochlear aqueduct. The resulting TM infrasonic pulsations can be measured by certain sensors. Elevated ICP alters brain compliance, which appears to yield slower rise times of the TM pulsation waveform. Measurement of this change may be useful in screening for elevated ICP. This paper investigates one such technique. Methods A stethoscope was modified for airtight external ear canal fit; the dome was exchanged for a magnetic reluctance pressure sensor, allowing measurement of TM pulsations. Analog TM pulsations were analyzed by measuring the pulsation's slope ratio between the waveform’s downslope and upslope. Seventeen normal subjects (ages 18-32 years) underwent hyperventilation and tilt table testing to induce ICP changes. An algorithm processed this data and predicted the subject's ICP status. Results The slope ratio method showed consistent and stable changes with the expected alterations in ICP from the tilt test and hyperventilation maneuvers. The classification algorithm correctly identified subjects with elevated ICP in 60 of 60 independent recordings on 17 subjects. Conclusion This paper has four conclusions. First, the "brain stethoscope" can detect increased ICP from the TM pulsation waveform in healthy subjects. Second, analysis of the TM waveform using slope ratio calculations is capable of distinguishing normal versus elevated ICP. Third, the tilt and hyperventilation maneuvers showed the expected physiologic trends. Last, further studies are needed on patients with pathological ICP before the brain stethoscope can be implemented into clinical practice.