What Is Tinnitus?
Tinnitus is the general term used to describe the perception of sounds such as ringing, buzzing, whistling, or humming in the ear or head without an external sound source. This symptom may occur alongside hearing loss or may result from multisystem factors, including musculoskeletal disorders that interact with the somatosensory system.
The Relationship Between Manual Therapy and Tinnitus
Tinnitus is not a condition that can be treated directly; rather, it presents as a symptom of various underlying factors. In particular, dysfunctions of the cervical region (neck) and temporomandibular joint (TMJ) disorders may influence the presence or severity of certain types of tinnitus. This subtype is referred to as somatosensory tinnitus and is associated with the musculoskeletal system.
In this context, manual therapy is considered a therapeutic approach that primarily focuses on improving the function of the neck, jaw, and surrounding musculoskeletal structures, with the potential to reduce tinnitus severity and related impairments in quality of life.
Scientific Evidence and Clinical Studies
1. Effects of Cervico-Mandibular Manual Therapy
A randomized controlled clinical trial demonstrated that in tinnitus patients with temporomandibular disorders (TMD), a physiotherapy program that included manual therapy resulted in significantly better outcomes compared to a program consisting solely of exercise and patient education:
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A significant reduction in tinnitus severity (THI scores)
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Greater improvement in tinnitus-related daily life handicap and TMD-related pain
These findings suggest that manual therapy interventions targeting the cervical and jaw regions may positively influence tinnitus-related symptoms.
2. Manual Therapy for Cervicogenic Somatosensory Tinnitus
Another pilot study found that an intervention consisting of manual therapy combined with stretching and muscle relaxation techniques applied to the head and neck region significantly reduced tinnitus symptoms and cervical muscle pressure pain.
The study observed notable improvements in tinnitus severity scores and head/neck-related symptoms, supporting the potential benefit of manual therapy in cervicogenic (neck-related) forms of tinnitus.
3. Systematic Reviews
Systematic reviews examining multiple clinical studies have also shown that combinations of manual therapy and exercise can reduce tinnitus severity. These positive outcomes are particularly evident in patients whose tinnitus is accompanied by temporomandibular or cervical dysfunction.
Possible Mechanisms
Theoretical mechanisms through which manual therapy may influence tinnitus include:
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Reduction of tension and compressive stress in the cervical and jaw musculature, potentially modulating somatosensory signaling and tinnitus perception
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Restoration of musculoskeletal function, helping to balance interactions between cervical nerves, the trigeminal system, and auditory pathways
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Mobilization and relaxation of the neck and jaw muscles, which may alleviate tinnitus symptoms
These mechanisms are thought to act primarily by reducing somatic contributions to tinnitus rather than directly altering auditory thresholds.
Clinical Practice Recommendations
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Assessment of patients with somatosensory tinnitus: Manual therapy may be considered when symptoms of cervical or TMJ dysfunction are present.
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Multimodal approach: Manual therapy is generally more effective when combined with therapeutic exercises, patient education, and appropriate postural training.
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Individualized treatment planning: Each tinnitus patient presents unique characteristics; therefore, treatment plans should be tailored based on individual assessment.
Conclusion
Although current literature does not demonstrate that manual therapy directly alters auditory thresholds in tinnitus patients, it does suggest that manual therapy has the potential to reduce somatosensory tinnitus symptoms, particularly those associated with cervical and temporomandibular dysfunction.
For this reason, manual therapy may be considered a complementary treatment approach that can help reduce symptom severity and improve quality of life in individuals with tinnitus.
