Physiotherapy assessment and treatment of chronic subjective tinnitus using mechanical diagnosis and therapy: a case report

ABSTRACT

Objectives: Tinnitus is the perception of sound without any external auditory stimulus. Cervicogenic somatic tinnitus (CST) is a subset in which symptoms are modulated by maneuvers of the neck. The evidence for effective diagnosis and treatment of CST is limited. Mechanical Diagnosis and Therapy (MDT) is a biopsychosocial assessment and management system that uses the response to mechanical forces to classify clinical presentations accurately. The purpose of this case report is to describe the MDT assessment and management of a patient with chronic subjective tinnitus.

Methods: A 67-year-old female with a 5-year history of left-sided subjective tinnitus, neck pain, and headache was referred for physiotherapy. Outcome measures included the Visual Analogue Scale (VAS), Tinnitus Handicap Inventory (THI), and Neck Disability Index (NDI). She was evaluated and treated according to MDT principles with management consisting of individualized directional preference exercises and postural correction.

Results: Significant improvements in symptoms, cervical range of motion, function, and psychosocial status were observed over the long-term. At 6 months, THI scores dropped from 62/100 to 18/100 and NDI scores dropped from 18/50 to 3/50.

Discussion: A comprehensive MDT assessment led to a classification of Derangement, with treatment focusing on tailored self-management. Contrary to other interventions described for CST, the patient was able to make significant and lasting changes to her symptoms without the need for any externally applied interventions. The emphasis on self-management dovetails well with the biopsychosocial model of care. This case provides preliminary evidence for the utility of screening for Derangement in conservative tinnitus assessments.

Level of Evidence: 4

KEYWORDS:

• Tinnitus
• mechanical diagnosis and therapy
• MDT
• derangement
• directional preference

Disclosure statement

David Ham is contracted as a Diploma Educator with the McKenzie Institute International. Richard Rosedale is employed as the International Director of Education and an International Instructor for the McKenzie Institute International.

Additional information

Funding

The authors have no funding details to disclose.

Notes on contributors

Di Wu

Di Wu obtained his medical degree at China Medical University in 2004. He completed an orthopaedic surgery residency at Beijing Tiantan Hospital and worked as an orthopaedic surgeon at Fuxin Central Hospital from 2007 to 2010. After emigrating to Canada, he attended McGill University and received his Master of Science in Physical Therapy in 2013. He is now a clinical physiotherapist at Physio Cabrini, Montreal and treats a variety of musculoskeletal conditions and pelvic disorders. He has an interest in musculoskeletal conditions’ impact on other medical conditions. As a Certified Mechanical Diagnosis and Therapy (MDT) therapist, Di has innovatively used MDT as a screening tool to rule out spinal sources of pelvic pain and dysfunction and has described this approach in a published case series.

David Ham

David Ham graduated with a Master of Science in Physical Therapy from the University of Toronto in 2011. He is a clinical physiotherapist working in outpatient orthopaedics. He received the 2017 Phil Burchell MDT Diploma Scholarship in 2017 and obtained his Diploma in Mechanical Diagnosis and Therapy (Dip. MDT) in 2018. He is a Diploma Educator for the Theoretical Component of the McKenzie Institute International’s Diploma Program, co-teaching a module on Differential Diagnosis using MDT, and regularly assists on MDT courses presented to local clinicians.

Richard Rosedale

Richard Rosedale graduated from Guy’s Hospital School of Physiotherapy (London, UK) in 1992. After emigrating to Canada, he completed his Diploma in Mechanical Diagnosis and Therapy (Dip. MDT) in 1997. He worked in orthopaedics and provided musculoskeletal care at London Health Sciences Centre, Ontario between 1993 and 2018. He has been active in research since 2007 and has authored or coauthored over a dozen papers, primarily exploring the clinical utility of MDT. He has been the Institute’s Reference Coordinator since 2015. Since 2003 Richard has been one of the McKenzie Institute’s teaching faculty, instructing clinicians internationally in the principles, application of MDT. He has served on and chaired the scientific committees of many McKenzie Institute Conferences and is a Diploma examiner. In 2005 Richard was appointed onto the Institute’s International Education Council. He has since been involved in numerous educational projects including the development of online learning courses and other core educational materials. Richard was the recipient of the McKenzie Institute's 2014 Bronze Lady Award for his outstanding contributions over many years to both MDT research and MDT education. In 2018 Richard was appointed as the McKenzie Institute’s International Director of Education and Diploma Coordinator.