COMPARISON OF MANUAL THERAPY, TINNITUS RETRAINING THERAPY

This randomized controlled trial aims to compare the effectiveness of Manual Therapy (MT), Tinnitus Retraining Therapy (TRT), and their combination in adults with somatosensory tinnitus. Sixty-five participants will be randomly assigned to one of three parallel groups. Primary and secondary outcomes include tinnitus severity, tinnitus-related disability, neck disability, cervical range of motion, audiological measures, pressure pain threshold, anxiety, depression, and quality of life. Outcomes will be assessed before treatment and immediately after the six-week intervention period.

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. \-