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Somatic tinnitus is an unpleasant perception of sound that occurs in the absence of any external acoustic stimulus. Despite the correct diagnosis of somatic tinnitus, there is currently no specific treatment. The hypothesis of this study is that the application of manual therapy to the cervical region will help to treat tinnitus in patients. This study aims to investigate the effectiveness of manual therapy in the treatment of somatic tinnitus of cervicogenic origin.
Somatic tinnitus is an unpleasant perception of sound that occurs in the absence of any external acoustic stimulus. It results from complex interactions between the somatosensory and auditory systems, which involve the musculoskeletal system rather than the ear. The temporomandibular joint, craniocervical junction, cervical vertebrae and neck and shoulder muscles, in particular the sternocleidomastoid (SCM) muscle, upper trapezius and levator scapula, are anatomical regions that can cause somatic tinnitus.
Despite the correct diagnosis of somatic tinnitus, there is currently no specific treatment. The hypothesis of this study is that the application of manual therapy to the cervical region will help to treat tinnitus in patients. This study aims to investigate the effectiveness of manual therapy in the treatment of somatic tinnitus of cervicogenic origin.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Manual therapy + Exercise group | Experimental | Both groups will be instructed in the performance of isometric and strengthening exercises for the cervical region, which are provided to patients with cervical pain and limitation as a home programme for a six-week period. Additionally, patients in the manual therapy group will receive manual therapy on a weekly basis for a total of six sessions. |
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| Exercise group | Active Comparator | Both groups will be instructed in the performance of isometric and strengthening exercises for the cervical region, which are provided to patients with cervical pain and limitation as a home programme for a six-week period. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Manual Therapy | Other | Manual Therapy |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Visual Analogue Scale for Tinnitus (VAS-tinnitus) | The severity of tinnitus will be graded using a 10 cm visual analogue scale (VAS, 0-10 cm; 0 means no tinnitus, 10 means extremely severe tinnitus). | baseline- week 3 - week 6 |
| Measure | Description | Time Frame |
|---|---|---|
| Visual Analogue Scale for cervical pain (VAS-Cervical) | Pain intensity will be assessed with the visual analogue scale (0-10mm), which has proven validity and reliability for measuring musculoskeletal pain. | baseline- week 3 - week 6 |
| Tinnitus Handicap Index (THI) |
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Inclusion Criteria:
Patients aged ≥ 18 and ≤ 65 years Patients fulfilling the clinical criteria4 defined for sevichogenic somatic tinnitus
Exclusion Criteria:
Objective tinnitus Subjective tinnitus with hearing loss Meniere's disease History of vertigo Middle ear pathologies History of intracranial pathology History of whiplash injury History of cervical spinal surgery History of active infection, malignancy, inflammatory rheumatic disease or fibromyalgia Pregnancy Patients who have undergone any exercise or physiotherapy programme for the cervical region in the last 3 months
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Gaziler Physical Medicine and Rehabilitation Educiation and Research Hospital | Ankara | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41863305 | Derived | Atan D, Atan T, Cakir Agca BN, Guzelkucuk U. Effectiveness of manual therapy in the treatment of somatic tinnitus: a randomized controlled trial. Physiother Theory Pract. 2026 Mar 21:1-11. doi: 10.1080/09593985.2026.2647791. Online ahead of print. |
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| ID | Term |
|---|---|
| D014012 | Tinnitus |
| ID | Term |
|---|---|
| D006311 | Hearing Disorders |
| D004427 | Ear Diseases |
| D010038 | Otorhinolaryngologic Diseases |
| D012678 | Sensation Disorders |
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| ID | Term |
|---|---|
| D026201 | Musculoskeletal Manipulations |
| D015444 | Exercise |
| ID | Term |
|---|---|
| D000529 | Complementary Therapies |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
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| Exercise |
| Other |
Isometric and strengthening exercises for the cervical region, which are provided to patients with cervical pain and limitation |
|
The THI contains a total of 25 items with functional (11 items), emotional (9 items) and catastrophic (5 items) subscales. Each item is rated 0 (not affected), 2 (sometimes affected) or 4 (always affected). The total score ranges from 0 to 100, with higher scores indicating higher levels of disability of perceived tinnitus. |
| baseline- week 3 - week 6 |
| Neck disability index (NDI) | The NDI is designed to assess self-reported neck functional status. The questionnaire consists of 10 items related to pain, activities of daily living, weight lifting, reading, headache, concentration, working status, driving, sleep and recreation and is rated on a 6-point Likert scale ranging from 0 (no disability) to 50 (major disability). Higher scores represent greater disability. The NDI has been found to be reliable and valid for cervical disorders. | baseline- week 3 - week 6 |
| Cervical range of motion (ROM) | Cervical range of motion (ROM) | baseline -week 3- week 6 |
| Manual muscle testing (MMT) | MMT for assessing strength of cervical flexors, extensors, lateral flexors, and rotators | baseline - week 3 -week 6 |
| Myofascial trigger point of the SCM, upper trapezius, levator scapulae, splenius capitis | Myofascial trigger point of the SCM, upper trapezius, levator scapulae, splenius capitis | baseline- week 3- week 6 |
| Tinnitus provocation with ROM | Tinnitus provocation with ROM | Baseline- week 3- week 6 |
| Tinnitus provocation with MMT | Tinnitus provocation with MMT | Baseline- week 3- week 6 |
| Tinnitus provocation with myofascial trigger point palpation | Tinnitus provocation with myofascial trigger point palpation | Baseline- week 3- week 6 |
| SF-36 quality of life scores | SF-36 is a widely validated and reliable generic measure of health-related quality of life, covering eight domains: physical functioning, role limitations due to physical and emotional problems, pain, general health, vitality, social functioning, and mental health. Each subscale score ranges from 0 (worst) to 100 (best) | Baseline- week 3- week 6 |
| D009461 |
| Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009043 |
| Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |