title: Cervicogenic somatosensory tinnitus: An indication for manual therapy plus education? Part 2: A pilot study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of Manual Therapy Utrecht (MTU) plus education in patients with cervicogenic somatosensory tinnitus (CeT).
  
  
  METHODS
  Pretest-posttest design.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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: rob.oostendorp@planet.nl.
authors.forename: Rob A B
authors.initials: RA
authors.lastname: Oostendorp
authors.affiliation: Practice for Manual Therapy, Arnhem, The Netherlands.
authors.forename: Iem
authors.initials: I
authors.lastname: Bakker
authors.affiliation: Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Institute for Methodology and Statistics Beuningen, Beuningen, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Elvers
authors.affiliation: 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.
authors.forename: Emilia
authors.initials: E
authors.lastname: Mikolajewska
authors.affiliation: 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.
authors.forename: Sarah
authors.initials: S
authors.lastname: Michiels
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Willem
authors.initials: W
authors.lastname: De Hertogh
authors.affiliation: Department Medical Psychology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Han
authors.initials: H
authors.lastname: Samwel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000193:education*; D009426:Netherlands; D010353:Patient Education as Topic; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Cervical spine; Education; Manual therapy; Outcome; Somatosensory tinnitus; Tinnitus sensitization