J Am Acad Audiol 2019; 30(08): 720-730
DOI: 10.3766/jaaa.17147
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Long-Term Effects of a Multimodal Physiotherapy Program on the Severity of Somatosensory Tinnitus and Identification of Clinical Indicators Predicting Favorable Outcomes of the Program

Claudia Côté
*   Centre Intégré Universitaire de santé et services sociaux de La Capitale-Nationale, Quebec City, Canada
Isabelle Baril
*   Centre Intégré Universitaire de santé et services sociaux de La Capitale-Nationale, Quebec City, Canada
Catherine-Ève Morency
*   Centre Intégré Universitaire de santé et services sociaux de La Capitale-Nationale, Quebec City, Canada
Samuel Montminy
*   Centre Intégré Universitaire de santé et services sociaux de La Capitale-Nationale, Quebec City, Canada
Mélanie Couture
*   Centre Intégré Universitaire de santé et services sociaux de La Capitale-Nationale, Quebec City, Canada
Jean Leblond
†   Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
Marianne Roos
†   Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
Jean-Sébastien Roy
†   Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
‡   Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
› Author Affiliations
Further Information

Publication History

22 March 2018

Publication Date:
25 May 2020 (online)



Tinnitus, the perception of sound in the absence of external auditory stimuli, is commonly associated with problems of the auditory system. Head and neck disorders can also be involved in tinnitus emergence. In such cases, the term somatosensory tinnitus is used. Physiotherapy treatments have been identified as a promising avenue in the treatment of somatosensory tinnitus.


The aim of the study was to explore the effect of a physiotherapy program on the intensity and severity of somatosensory tinnitus and to identify the clinical characteristics of the patients who respond well to this treatment.

Research Design:

Quasi-experimental pre–post single-group design.

Study Sample:

Thirty-one adults with presumed somatosensory tinnitus.


All participants received on average ten physiotherapy treatments over six weeks. Treatments included cervical and thoracic mobilizations, as well as muscular strengthening, stretching, postural instruction, and cervical stabilization.

Data Collection and Analysis:

Outcomes were measured at baseline, at the end of the physiotherapy program, and three months later. The primary outcomes were the Tinnitus Handicap Inventory and visual analog scales for loudness and annoyance caused by tinnitus.

After the last evaluation, participants were divided into two groups: improved and unimproved participants. Participants were considered improved if they (1) showed significant improvement in at least two of the three primary outcome measures and (2) indicated subjective improvement. Thereafter, the baseline characteristics that correctly identify participants susceptible to improve significantly following treatment were determined (Cohen’s effect size d > 0.8).


A significant improvement in tinnitus intensity was observed at the end of the program. Of the 31 participants, 14 experienced persistent improvement in the intensity of their tinnitus and were classified as improved. Baseline characteristics strongly associated with tinnitus improvement were no increase in tinnitus when exposed to noise (d = −1.57), no family history of tinnitus (d = −1.16), somatosensory modulation in response to the contraction used to resist pressure applied to the forehead (d = 1.20), and recent onset of tinnitus (d = 1.03).


This exploratory study showed that a multimodal physiotherapy program is effective in decreasing the severity of tinnitus, principally in individuals presenting with somatosensory tinnitus in combination with specific clinical characteristics.

This study was supported by the Institut de réadaptation en déficience physique de Québec (IRDPQ) Auditory Disability Research Fund (fonds de recherche en déficience auditive de l’IRDPQ) and the IRDPQ.

Supplementary Material


  • Adamchic I, Langguth B, Hauptmann C, Tass PA. 2012; Psychometric evaluation of visual analog scale for the assessement of chronic tinnitus. Am J Audiol 21: 215-225
  • Cherian K, Cherian N, Cook C, Kaltenbach JA. 2013; Improving tinnitus with mechanical treatment of cervical spine and jaw. J Am Acad Audiol 24: 544-555
  • Childs JD, Piva SR, Fritz JM. 2005; Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 30: 1331-1334
  • Dehmel S, Pradhan S, Koehler S, Bledsoe S, Shore S. 2012; Noise overexposure alters long-term somatosensory-auditory processing in the dorsal cochlear nucleus–possible basis for tinnitus-related hyperactivity?. J Neurosci 32 (05) 1660-1671
  • Elgoyhen AB, Langguth B. 2010; Pharmacological approaches to the treatment of tinnitus. Drug Discov Today 15 (7/8) 300-305
  • Freeston MH, Ladouceur R, Thibodeau N, Gagnon F, Rhéaume J. 1994; L’inventaire d’anxiété de Beck: propriétés psychométriques d’une traduction française. L’Encéphale 20: 47-55
  • Ghulyan-Bédikian V, Paolino M, Giorgetti-D’Esclers F, Paolino F. 2010; Propriétés psychométriques d’une version française du Tinnitus Handicap Inventory. L’Encéphale 36: 390-396
  • Herraiz C. 2008; Assessing the cause of tinnitus for therapeutic options. Expert Opin Med Diagn 2: 1183-1196
  • Kujawa SG, Liberman MC. 2009; Adding insult to injury: cochlear nerve degeneration after “temporary” noise-induced hearing loss. J Neurosci 29: 14077-14085
  • Langguth B, Goodey R, Azevedo A, Bjorne A, Cacace A, Crocetti A, Del Bo L, De Ridder D, Diges I, Elbert T, Flor H, Herraiz C, Sanchez TG, Eichhammer P, Figueiredo R, Hajak G, Kleinjung T, Landgrebe M, Londero A, Lainez MJA, Mazzoli M, Meikle MB, Melcher J, Rauschecker JP, Sand PG, Struve M, Van De Heyning P, Van Dijk P, Vergara R. 2007; Consensus for tinnitus patient assessment and treatment outcome measurement: tinnitus research initiative meeting, Regensburg. Prog Brain Res 166: 525-536
  • Levine RA. 2004. Somatic tinnitus. In: Snow JB. Tinnitus: Theory and Management. Lewiston, NY: BC Decker; 108-124
  • Levine RA. 2013; Tinnitus: diagnostic approch leading to treatment. Semin Neurol 33: 256-269
  • Levine RA, Nam EC, Oron Y, Melcher JR. 2007; Evidence for a tinnitus subgroup responsive to somatosensory based treatment modalities. Prog Brain Res 166: 195-207
  • Maitland G, Hengeveld E, Banks K, English K. 2005. Maitland’s Vertebral Manipulation. 7th ed. Philadelphia, PA: Elsevier/Butterworth-Heinemann;
  • Miller J, Gross A, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL. 2010; Manual therapy and exercise for neck pain: a systematic review. Man Ther 15: 334-354
  • Michiels S, De hertogh W, Truijen S, Van de Heyning P. 2015; a Cervical spine dysfunctions in patients with chronic subjective tinnitus. Otol Neurotol 36: 741-745
  • Michiels S, Van de Heyning P, Truijen S, Hertogh W. 2015; b Diagnostic value of clinical cervical spine tests in patients with cervicogenic somatic tinnitus. Phys Ther 95: 1529-1535
  • Michiels S, Naessens S, Van de Heyning P, Braem M, Visscher CM, Gilles A, De Hertogh W. 2016; a The effect of physical therapy treatment in patients with subjective tinnitus: a systematic review. Front Neurosci 10: 545
  • Michiels S, Van de Heyning P, Truijen S, Hallemans A, Hertogh W. 2016; b Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?. Man Ther 26: 125-131
  • Michiels S, Van de Heyning P, Truijen S, Hallemans A, Hertogh W. 2017; Prognostic indictors for decrease in tinnitus severity after cervical physical therapy in patients with cervicogenic somatic tinnitus. Musculoskelet Sci Pract 29: 33-37
  • Rey-Eiriz G, Alburquerque-Sendín F, Barrera-Mellado I, Martín-Vallejo FJ, Fernández-de-las-Peñas C. 2010; Validity of the posterior-anterior middle cervical spine gliding test for the examination of intervertebral joint hypomobility in mechanical neck pain. J Manipulative Physiol Ther 33: 279-285
  • Sanchez TG, Rocha CB. 2011; a Diagnosis and management of somatosensory tinnitus: review article. Clinics 66: 1089-1094
  • Sanchez TG, Rocha CB. 2011. b Diagnosis of somatosensory tinnitus. In: Moller DAR, Langguth B, DeRidder D, Kleinjung T. Textbook of Tinnitus. New York, NY: Springer; 429-433
  • Sandmark H, Nisell R. 1995; Validity of five common manual neck pain provoking tests. Scand J Rehabil Med 27: 131-136
  • Shore SE, Roberts LE, Langguth B. 2016; Maladaptive plasticity in tinnitus-trigger, mechanismes and treatment. Nat Rev Neurol 12: 150-160
  • Wlodyka-Demaille S, Poiraudeau S, Catanzariti JF, Rannou F, Fermanian J, Revel M. 2002; French translation and validation of 3 functional disability scales for neck pain. Arch Phys Med Rehabil 83: 376-382
  • Wu C, Stefanescu RA, Martel DT, Shore SE. 2016; Tinnitus: maladaptive auditory-somatosensory plasticity. Hear Res 334: 20-29
  • Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. 2009; Responsiveness of the neck disability index in patients with mechanical neck disorders. Spine 9: 802-808
  • Youdas JW, Garrett TR, Suman VJ, Bogard CL, Hallman HO, Carey JR. 1992; Normal range of motion of the cervical spine: an initial goniometric study. Phys Ther 72: 770-780
  • Zeman F, Koller M, Figueiredo R, Aazevedo A, Rates M, Coelho C, Kleinjung T, de Ridder D, Langguth B, Landgreb M. 2011; Tinnitus handicap inventory for evaluating treatment effects: which changes are clinically relevant?. Otolaryngol Head Neck Surg 145: 282-287