Cervicogenic Somatic Tinnitus Significantly Reduced by Physical Therapy

Michiels S, Van de Heyning P, Truijen S, Hallemans A, De Hertogh W. Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus? Man Ther. 2016;26:125-131. doi:10.1016/j.math.2016.08.005

Physical therapy researchers at Antwerp University Hospital in Belgium assessed the effect of multimodal physical therapy on patients with severe, nonfluctuating, subjective tinnitus that had been stable for 3 months combined with neck complaints. Exclusion criteria included vertigo, objective tinnitus, Meniere disease, severe depression, progressive middle ear pathology, intracranial pathology, traumatic cervical spine injury, tumors, and history of cervical spine surgery. Patients were randomized to an immediate-start group (n=19) or a 6-week delayed-start group (n=19).

The intervention was physical therapy for the cervical spine and included manual mobilizations (similar to osteopathic myofascial release), exercise therapy, and home exercises. The intervention was provided by master's degree–level physical therapists. Outcome measures were scores on the Tinnitus Functional Index (TFI) and the Neck Bournemouth Questionnaire (NBQ). All patients received the intervention for 6 weeks (12 sessions). Scores on the TFI and NBQ were taken at baseline, after 6 weeks for the delayed-start group, after the intervention for both groups, and after a 6-week follow-up. A global perceived effect scale was used to measure patients’ self-assessment at the above-mentioned points except at baseline.

After the intervention, results on the TFI (P=.04) and NBQ (P=.001) significantly decreased for all patients. Scores on the NBQ remained significantly lower at follow-up (P=.001). Immediately after the intervention, 53% of patients reported clinically relevant improvement in their tinnitus on the global perceived effect scale, but this percentage fell to 24% at the 12-week follow-up. No difference was found in TFI between immediate-start and delayed-start groups.

This article represents the research effort on manual therapy for conditions other than musculoskeletal disorders and also suggests a possible somatic origin for systemic disorders such as somatosensory tinnitus. In a 2016 pilot study,¹ Dutch researchers provided evidence supporting the successful application of very gentle, low-velocity passive movement of the joints of the spine, pelvis, and extremities for tinnitus. Osteopathic cranial manipulative medicine has also been reported to be of benefit in patients with tinnitus.² Although these studies do not constitute proof of the benefit of osteopathic manipulative treatment for patients with tinnitus, they certainly justify more extensive research on osteopathic manipulative treatment for patients with this condition.