Effectiveness of manual therapy in the treatment of somatic tinnitus: a randomized controlled trial

Abstract

Background Somatic tinnitus of cervicogenic and temporomandibular origin remains a therapeutic challenge, with limited evidence supporting manual interventions. Objective This study aimed to compare the efficacy of manual therapy combined with home-based exercises on tinnitus severity and outcomes in individuals with somatic tinnitus. Methods This single blinded randomized trial included 31 participants, allocated to manual therapy plus home exercises (n = 16) or home exercises alone (n = 15) for six weeks. All participants performed daily home exercises, with the manual therapy group receiving one weekly therapist session, totaling six. The primary outcome was tinnitus severity (visual analog scale, VAS). Secondary outcomes included cervical pain-VAS, Tinnitus Handicap Inventory (THI), Neck Disability Index (NDI), cervical range-of-motion (ROM), manual muscle testing, and Short Form-36 (SF-36) scores, assessed at baseline, week 3, and week 6. Results Significant interaction-effects favored the manual therapy group for tinnitus-VAS (p = .031, eta p(2) = 0.144), cervical pain-VAS (p = .031, eta p(2) = 0.219), THI (p = .038, eta p(2) = 0.136), and NDI (p = .020, eta p(2) = 0.164). Cervical ROM improved significantly in all directions, with group-effects in left lateral flexion (p = .012, eta p(2) = 0.199) and right rotation (p = .042, eta p(2) = 0.135). SF-36 improvements were noted in energy/fatigue (p = .005, eta p(2) = 0.246), general health (p = .012, eta p(2) = 0.198), and health change (p = .006, eta p(2) = 0.161). Conclusion Combining manual therapy with home exercises provided greater improvements in tinnitus severity, cervical symptoms, and quality of life in individuals with somatic tinnitus.