COMPARISON OF MANUAL THERAPY, TINNITUS RETRAINING THERAPY

Inclusion criteria

• Adults aged 18 to 65 years.
• Diagnosis of chronic subjective somatosensory tinnitus persisting for at least 3 months.
• Tinnitus that can be modulated by head, neck, jaw, or temporomandibular movements and/or cervical muscle palpation.
• Ability to understand the study procedures and provide written informed consent.
• Willingness to comply with the treatment protocol and attend all scheduled assessment and treatment sessions.
• Normal middle ear function as confirmed by immittance (tympanometry) testing.

Exclusion criteria

Objective or pulsatile tinnitus.

• Tinnitus duration of less than 3 months.
• Diagnosis of Ménière's disease, otosclerosis, vestibular schwannoma (acoustic neuroma), or other retrocochlear pathology.
• Active middle ear disease or abnormal immittance (tympanometry) findings.
• History of cervical spine surgery or severe cervical trauma.
• Presence of cervical spine fracture, instability, malignancy, inflammatory rheumatic disease, or other contraindications to manual therapy.
• Previous temporomandibular joint surgery or severe temporomandibular disorders requiring surgical treatment.
• Current participation in another clinical trial.
• Receipt of manual therapy, Tinnitus Retraining Therapy (TRT), or other tinnitus-specific rehabilitation within the previous 3 months.
• Severe neurological or psychiatric disorders that could interfere with participation or outcome assessment.
• Pregnancy.

Inability to understand study procedures, provide informed consent, or comply with the intervention schedule.

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