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Man Ther. 2016 Jun;23:106-13. doi: 10.1016/j.math.2016.02.006. Epub 2016 Feb 21.

Cervicogenic somatosensory tinnitus: An indication for manual therapy plus education? Part 2: A pilot study.

Author information

Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Pain in Motion International Research Group(1), Vrije Universiteit Brussel, Brussels, Belgium. Electronic address:
Practice for Manual Therapy, Arnhem, The Netherlands.
Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Institute for Methodology and Statistics Beuningen, Beuningen, The Netherlands.
Department of Physiotherapy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland; Rehabilitation Clinic, Military Clinical Hospital No. 10 with Polyclinic, Bydgoszcz, Poland; Neurocognitive Laboratory, Center for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland.
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Department Medical Psychology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.



The aim of this study was to evaluate the efficacy of Manual Therapy Utrecht (MTU) plus education in patients with cervicogenic somatosensory tinnitus (CeT).


Pretest-posttest design.


Five hundred and six patients were referred or referred themselves. A subgroup of patients was identified with CeT, and within this a subgroup with tinnitus sensitization (TS). Two CeT groups were created based on the presence or absence of TS. Both groups underwent manual therapy combined with tinnitus education. Tinnitus intensity (VAS-tin 0-100 mm) was the primary outcome measure. Number of treatments and adverse effects were the secondary outcome measures.


A total of 122 patients with CeT (24.1%) were included (average age 53.3 years [±9.8], female 38.5% and duration of tinnitus 7.3 years [±8.9]). Patients were divided into two groups: 55 patients (45.1%) with TS (CeT + TS group) and 67 patients (54.9%) without TS (CeT - TS group). Pretest to posttest differences on the VAS-tin were statistically significant within both groups (CeT - TS group: difference VAS-tin 5.9 [p = 0.01]; CeT + TS group: difference VAS-tin 18.2 [p = 0.00]), and between the groups in favor of the CeT + TS group (difference VAS-tin 12.3 [p = 0.01]). Pretest to posttest differences were clinically significant for the CeT + TS group (difference VAS-tin 18.2 [MCIC = ≥10 mm VAS-tin]) and between the groups (difference VAS-tin 12.3 in favor of the CeT + TS group). The average number of treatment sessions was 9.6 (±2.6) for the CeT - TS group and 10.3 (±2.5) for the CeT + TS group, a non-significant difference. There were no adverse effects in either group.


Despite its limitations, this study provides valuable information on both the characteristics of patients with CeT and TS in a Dutch primary care manual therapy practice and on the potential effectiveness of MTU combined with tinnitus education for the subgroup of CeT + TS patients.


Cervical spine; Education; Manual therapy; Outcome; Somatosensory tinnitus; Tinnitus sensitization

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