高齢者の末梢前庭障害への対応と難治例に対するTPADによる感覚代行治療

Benign paroxysmal positional vertigo (BPPV) is the most commonly encountered peripheral vestibular disorder in clinical practice. The prevalence rate of BPPV has been reported to be higher in older adults than in younger individuals. Although there is evidence for the effectiveness of the canalith repositioning procedure (CRP) for posterior canal BPPV, the success rate of this procedure has been reported to be significantly lower in older patients as compared with younger patients. Since BPPV often improves spontaneously, it is not necessary to perform the CRP in older patients with cervical or lumbar disorders. BPPV should be differentiated from other diseases, including central positional vertigo and vertebrobasilar insufficiency associated with the complaint of cervical vertigo.
Meniere's disease is more common in individuals aged 30-50 years and stress has been strongly suggested as being involved in its pathogenesis. The age of onset has been increasing gradually, with a trend towards increased incidence in older adults. Stressors and concerns unique to older adults, such as family caregiving for older adults, anxiety about health loss, and loneliness due to increases in sole–person households have been considered as possible causes. In 2020, the guideline for the treatment of Meniere's disease were revised to add positive pressure therapy for intractable Meniere's disease. Positive pressure therapy is non–invasive and easy to perform in older patients.
Recently, we have developed a wearable device, the Tilt Perception Adjustment Device (TPAD), that transmits vibratory input containing head–tilt information to the mandible to substitute for defective vestibular information in patients with unilateral and bilateral vestibulopathy. We assessed patients using the Dizziness Handicap Inventory (DHI) and performed gait analysis in older patients with unilateral and bilateral vestibulopathy. Three months after sensory substitution therapy using TPAD, the DHI and gait parameters in the patients with unilateral vestibulopathy improved on condition that the patients did even when the patients were not wearing the TPAD. In the patients with bilateral vestibulopathy, on the other hand, the gait parameters improved only on condition that, but only when they wore the TPAD. TPAD had potential applications as a wearable device, improving posture control in patients with unilateral and bilateral vestibulopathy.