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. 2022 Feb 28:3:100132.
doi: 10.1016/j.cccb.2022.100132. eCollection 2022.

Pulsatile tympanic membrane displacement is associated with cognitive score in healthy subjects

Anthony A Birch  1   2 , Wahbi K El-Bouri  1   3   4 , Robert J Marchbanks  1   2 , Laura A Moore  1 , Cherith M Campbell-Bell  1 , Christopher M Kipps  2   5 , Diederik O Bulters  2   6
Affiliations

Pulsatile tympanic membrane displacement is associated with cognitive score in healthy subjects

Anthony A Birch et al. Cereb Circ Cogn Behav. .

Abstract

To test the hypothesis that pulsing of intracranial pressure has an association with cognition, we measured cognitive score and pulsing of the tympanic membrane in 290 healthy subjects. This hypothesis was formed on the assumptions that large intracranial pressure pulses impair cognitive performance and tympanic membrane pulses reflect intracranial pressure pulses. 290 healthy subjects, aged 20-80 years, completed the Montreal Cognitive Assessment Test. Spontaneous tympanic membrane displacement during a heart cycle was measured from both ears in the sitting and supine position. We applied multiple linear regression, correcting for age, heart rate, and height, to test for an association between cognitive score and spontaneous tympanic membrane displacement. Significance was set at P < 0.0125 (Bonferroni correction.) A significant association was seen in the left supine position (p = 0.0076.) The association was not significant in the right ear supine (p = 0.28) or in either ear while sitting. Sub-domains of the cognitive assessment revealed that executive function, language and memory have been primarily responsible for this association. In conclusion, we have found that spontaneous pulses of the tympanic membrane are associated with cognitive performance and believe this reflects an association between cognitive performance and intracranial pressure pulses.

Keywords: Cognitive assessment; Intracranial pressure; MOCA; Pulsatility; Tympanic membrane displacement.

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Conflict of interest statement

Dr. Marchbanks is the majority shareholder in Marchbanks Measurement Systems Ltd, a spinout from Southampton University that manufactures the TMD Analyser for clinical evaluation purposes. None of the other authors have any competing interest to declare.

Figures

Fig 1
Fig. 1
Illustrating a mechanical link from the intracranial fluids in the posterior fossa via the cochlear aqueduct to the inner ear and from there through the ossicles to the tympanic membrane.
Fig 2
Fig. 2
Example showing a sample of data and illustrating how the ECG is used to extract heartbeats from a continuous trace of tympanic membrane displacement.
Fig 3
Fig. 3
Dot plots showing the association between MOCA score and spTMD, each volunteer in the study is represented as a dot on each of the plots for which they gave data. The trendlines and correlation values (R) are for illustration only, they have been fitted by conventional least squares fit of all data points which assumes that the MOCA score is a continuous linear variable, it is actually an ordinal variable and has been treated as ordinal or categorical in all analysis
Fig 4
Fig. 4
Pulse waveforms of tympanic membrane displacement during a heartbeat, showing the average for each cognitive assessment score.
See this image and copyright information in PMC

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