Störungen des Gehörs und des Geruchs bei endokraniellen Erkrankungen: Mit 13 Textabbildungen

Noninvasive detection of elevated ICP using spontaneous tympanic membrane pulsation

Neurological conditions such as traumatic brain injury (TBI) and hydrocephalus may lead to intracranial pressure (ICP) elevation. Current diagnosis methods rely on direct pressure measurement, while CT, MRI and other expensive imaging may be used. However, these invasive or expensive testing methods are often delayed because symptoms of elevated ICP are non-specific. Invasive methods, such as intraventricular catheter, subdural screw, epidural sensor, lumbar puncture, are associated with an increased risk of infection and hemorrhage. On the other hand, noninvasive, low-cost, accurate methods of ICP monitoring can help avoid risks and reduce costs while expediting diagnosis and treatment. The current study proposes and evaluates a novel method for noninvasive ICP monitoring using tympanic membrane pulsation (TMp). These signals are believed to be transmitted from ICP to the auditory system through the cochlear aqueduct. Fifteen healthy subjects were recruited and TMp signals were acquired noninvasively while the subjects performed maneuvers that are known to change ICP. A custom made system utilizing a stethoscope headset and a pressure transducer was used to perform these measurements. Maneuvers included head-up-tilt, head-down-tilt and hyperventilation. When elevated ICP was induced, significant TMp waveform morphological changes were observed in each subject (p < 0.01). These changes include certain waveform slopes and high frequency wave features. The observed changes were reversed by the maneuvers that decreased ICP (p < .01). The study results suggest that TMp waveform measurement and analysis may offer an inexpensive, noninvasive, accurate tool for detection and monitoring of ICP elevations. Further studies are warranted to validate this technique in patients with pathologically elevated ICP.

Noninvasive intracranial pressure measurement using infrasonic emissions from the tympanic membrane

OBJECTIVE

We investigated whether ICP can be assessed by measuring infrasonic emissions from the tympanic membrane.

METHODS

An increase in ICP was induced in 22 patients with implanted ICP pressure sensors. ICP waveforms that were obtained invasively and continuously were compared with infrasonic emission waveforms. In addition, the noninvasive method was used in a control group of 14 healthy subjects.

RESULTS

In a total of 83 measurements, the changes in ICP that were observed in response to different types of stimulation were detected in the waveforms obtained noninvasively as well as in those acquired invasively. Low ICP was associated with an initial high peak and further peaks with smaller amplitudes. High ICP was associated with a marked decrease in the number of peaks and in the difference between the amplitudes of the initial and last peaks. The assessment of infrasonic emissions, however, does not yet enable us to provide exact figures.

CONCLUSION

It is conceivable that the assessment of infrasonic emissions will become suitable both as a screening tool and for the continuous monitoring of ICP in an intensive care environment.

[Evaluating function and disorders of smell]

Firstly the review deals with the olfactometry after discussing the olfactory and trigeminal sensitivity of the sense of smell. The term olfactometry will be newly fixed concerning the present problems of odor analysis. Under clinical aspects the methods of subjective olfactometry are discussed and valued. Olfactory tests basing on registering several psychosomatic reflexes (e.g. cardial and/or respiratory frequencies) cannot be described as "objective". Rather methods are objective which record poststimulatory electrophysiological events at different steps of olfactory pathways. The electric response olfactometry representing a cortical evoked so-called twin-potential containing equivalents for trigeminal and olfactory sense activity starts to demonstrate its efficiency. At least a complete test of olfactory function today includes the rhinomanometry for recording ability in nasal odor transport capacity. In the second part are discussed the olfactory disorders with clinical importance. Air borne disorders are confronted with sensorineural, which again are divided in prebulbar, bulbar, and postbulbar ones so far as possible. Respiratory smell disorders depend on nasal ventilation and occur in nasal deformations, in abnormalities of respiratory pathways, in cases of foreign bodies, mucosal inflammations, tumors, intoxications and allergy. Sensorineural olfactory disorders can be attached to age, to malformations or idiopathic defects, inflammations of the olfactory-neural apparatus, head injuries, brain tumors, metabolic or endocrinological diseases. Furthermore often they are accompanied with neurological and psychiatric diseases or professional and chemical intoxications and/or iatrogenic influences. The poor therapeutical possibilities are demonstrated as far as possible. Finally the experting problems in olfactory disorders are delineated, at which the evidence of objective olfactometry can be distincted.