Manual Therapy for Cervicogenic Tinnitus and Dizziness

Tinnitus—commonly described as ringing in the ears—affects over 740 million people globally, with more than 120 million experiencing it as a serious condition. While many cases are associated with hearing loss or inner ear disorders, a growing number of patients report tinnitus related to muscular and joint dysfunction in the neck and jaw. This form is known as cervicogenic somatosensory tinnitus (CST).

A randomized controlled trial from Hannover Medical School in Germany explored the effects of manual therapy on patients with CST, offering important insights for physiotherapists and bodywork professionals.

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Understanding Cervicogenic Tinnitus

CST refers to tinnitus triggered or modulated by movement or muscle tension in the cervical spine, jaw, or related musculature. Patients with CST often experience:

• Changes in tinnitus pitch or loudness during head, neck, or jaw movement
• Associated dizziness or vertigo
• Pressure-sensitive trigger points in head, neck, and shoulder muscles

Tension in muscles like the splenius capitis, semispinalis capitis, levator scapulae, and trapezius may contribute to brainstem irritation. This in turn is thought to activate auditory and vestibular pathways, linking muscle dysfunction to symptoms of tinnitus and dizziness.

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Study Design

This clinical trial included 70 adult patients with chronic or acute subjective tinnitus, with or without dizziness and cervical spine complaints. Patients were randomized into two groups:

• Intervention Group: Received 13–18 manual therapy sessions over several weeks, targeting the head, neck, and jaw muscles.
• Control Group: Waitlist, with no treatment during the initial assessment period.

Each patient was assessed at baseline and post-treatment using:

• Tinnitus Handicap Inventory (THI)
• Dizziness Handicap Inventory (DHI)
• Manual palpation for pressure pain and symptom modulation
• Cervical Range of Motion (CROM) measurements

Therapy included stretching, myofascial release, trigger point therapy, and education on daily home exercises.

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Key Results for Therapists

1. Symptom Modulation

Patients in the treatment group experienced significantly reduced sensitivity in pressure points and greater reduction in tinnitus modulation after therapy. Manual palpation showed improvement in 14 out of 18 muscles, including deep cervical extensors and jaw muscles.

2. Reduced Pain in Key Muscles

Post-treatment evaluations showed significantly less pressure pain in 10 muscles, especially in the masseter, levator scapulae, and semispinalis capitis.

3. Improved Neck Mobility

Patients in the intervention group gained significantly more rotational range of motion to both sides compared to controls. This is clinically relevant for therapists working with restricted cervical rotation due to muscle tightness.

4. Tinnitus Impact

Nearly half (48.6%) of the treatment group showed a strong reduction in THI scores, indicating marked improvement in tinnitus-related distress. Only 6% of the control group showed similar improvement.

5. Dizziness Relief

Patients with combined dizziness and tinnitus showed significant reduction in DHI scores. Most experienced a shift from moderate to mild or no symptoms—supporting manual therapy as a potential approach for treating cervicogenic dizziness.

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Clinical Implications for Practice

This study demonstrates that targeted manual therapy can:

• Reduce muscle hypertonicity in neck and jaw regions
• Improve auditory and vestibular symptoms such as tinnitus and dizziness
• Positively affect quality of life by addressing both physical and emotional distress associated with CST

Manual therapy should be considered in treatment plans for patients with:

• Chronic tinnitus with no apparent inner ear pathology
• Tinnitus modulated by movement or muscle palpation
• Concurrent neck pain or jaw dysfunction
• Associated symptoms like dizziness or pressure sensitivity

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What This Means for Therapists

Manual therapists, physiotherapists, and bodyworkers are uniquely positioned to identify and treat CST. Key muscles to assess include:

• Cervical extensors: Splenius capitis, semispinalis capitis
• Shoulder girdle: Trapezius, levator scapulae
• Jaw muscles: Masseter, temporalis, pterygoids

Incorporating clinical assessment for tinnitus modulation and applying soft tissue techniques, stretching, and posture correction may offer substantial benefits. Education in CST-related anatomy and symptom behavior is critical for safe and effective intervention.

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Final Notes

This study marks a significant step forward in recognizing tinnitus as more than an ear problem. For therapists, it reinforces the value of a whole-body approach—one that connects muscular health, neurology, and symptom modulation. While more research is needed to refine protocols and identify long-term effects, manual therapy offers a promising avenue for clients who have long struggled with tinnitus and associated dizziness.