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. \-