Clinical comparison of tympanic membrane displacement with invasive intracranial pressure measurements

Abstract

A non-invasive method of assessing intracranial pressure (ICP) would be of benefit to patients with abnormal cerebral pathology that could give rise to changes in ICP. In particular, it would assist the regular monitoring of hydrocephalus patients. This study evaluated a technique using tympanic membrane displacement (TMD) measurements, which has been reported to provide a reliable, non-invasive measure of ICP. A group of 135 hydrocephalus patients was studied, as well as 13 patients with benign intracranial hypertension and a control group of 77 volunteers. TMD measurements were carried out using the Marchbanks measurement system analyser and compared between the groups. In 36 patients, invasive measurements of ICP carried out at the same time were compared with the TMD values. A highly significant relationship was found between TMD and ICP but intersubject variability was high and the predictive value of the technique low. Taking the normal range of ICP to be 10–15 mmHg, the predictive limits of the regression are an order of magnitude wider than this and therefore Vm cannot be used as a surrogate for ICP. In conclusion, TMD measurements do not provide a reliable non-invasive measure of ICP in patients with shunted hydrocephalus.