Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial

Objective. This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporomandibular disorders (TMDs). Methods. Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy and manual therapy group or physiotherapy alone group. All patients received six sessions of physiotherapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervicomandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus-related handicap (Tinnitus Handicap Inventory [THI]), TMD-related disability (Craniofacial Pain and Disability Inventory [CF-PDI]), self-rated quality of life (12-item Short Form Health Survey [SF-12]), depressive symptoms (Beck Depression Inventory [BDI-II]), pressure pain thresholds (PPTs), and mandibular range of motion. Patients were assessed at baseline, one week, three months, and six months after intervention by a blinded assessor. Results. The adjusted analyses showed better outcomes (all, P< 0.001) in the exercise/education plus manual therapy group (large effect sizes) for TMD pain (eta 2 P= 0.153), tinnitus severity (eta 2 P= 0.233), THI (eta 2 P= 0.501), CF-PDI (eta 2 P= 0.395), BDI-II (eta 2 P= 0.194), PPTs (0.363 < eta 2 P< 0.415), and range of motion (eta 2 P= 0.350), but similar changes for the SF-12 (P=0.622, eta 2 P= 0.01) as the exercise/education alone group. Conclusions. This clinical trial found that application of cervico-mandibular manual therapies in combination with exercise and education resulted in better outcomes than application of exercise/ education alone in individuals with tinnitus attributed to TMD.