Tinnitus affects roughly 15% of the global population. For most of them, the clinical experience follows a familiar pattern: hearing test, normal result, referral back to the GP, advice to manage stress and avoid loud noise. Many are told there is nothing that can be done.

For some of them, this is accurate. For a significant subset, it is not — because the tinnitus is not audiological in origin. It is somatic, and it responds to treatment.

What the Evidence Says About Standard Tinnitus Treatments

Sound therapy and masking. White noise machines and masking devices can reduce the perceived loudness of tinnitus and make it easier to sleep and concentrate. They do not treat the underlying cause. For people with chronic tinnitus, they are a useful management tool — not a solution.

Cognitive behavioural therapy. CBT has the strongest evidence base of any psychological intervention for tinnitus distress. It does not reduce the volume of the tinnitus, but it significantly reduces the distress associated with it. For people whose tinnitus is not treatable at the source, CBT is currently the most evidence-supported intervention available.

Tinnitus retraining therapy. Combines sound therapy with directive counselling to habituate the brain's response to the tinnitus signal. Evidence is mixed, and results vary considerably between individuals.

Medication. No medication has been shown to reliably reduce tinnitus in high-quality clinical trials. Some medications — particularly certain antidepressants and anxiolytics — can reduce the distress associated with tinnitus, but they do not address the sound itself.

Dietary supplements. Ginkgo biloba, zinc, magnesium, and various other supplements are widely marketed for tinnitus. The evidence does not support their use for tinnitus reduction in people without a documented deficiency.

The Somatic Exception

Somatic tinnitus — tinnitus that is modulated or caused by the musculoskeletal system — is a distinct subtype that responds to a completely different approach. The key diagnostic feature is somatosensory modulation: the tinnitus changes in pitch or loudness with neck movement, jaw movement, or pressure on specific muscles.

If your tinnitus can be changed by physical action, it has a physical component. And physical components can be treated physically.

The evidence for cervical physiotherapy in somatic tinnitus is still emerging, but the clinical results are consistent: patients with documented neck dysfunction and somatic modulation of their tinnitus show meaningful improvement with targeted cervical intervention. The two published studies underlying the Reliev program document this in patients treated across multiple countries.

How to Know If Your Tinnitus Has a Somatic Component

Try the following:

  • Turn your head slowly to the left and right — does the tinnitus change?
  • Press gently on the muscles at the base of your skull — does the pitch or volume shift?
  • Clench your jaw firmly for a few seconds, then release — is there any change?
  • Look up at the ceiling and hold for 10 seconds — does the tinnitus change?

If you notice any modulation — even subtle — there is a somatic component worth investigating. This does not mean the tinnitus is entirely musculoskeletal, but it means the musculoskeletal system is involved in generating or amplifying the signal.

What to Do Next

If you suspect somatic tinnitus, the most useful next step is to start working on cervical mobility and muscle tension systematically and observe whether the tinnitus responds over four to six weeks. This requires consistency — occasional exercises will not produce meaningful results. Daily practice, targeting the upper cervical spine, suboccipital muscles, and jaw, gives the best chance of a response.

This is not a guarantee. Not all tinnitus is somatic, and not all somatic tinnitus resolves completely with physiotherapy. But for people who have been told nothing can be done and who have not yet explored the musculoskeletal angle, it is a rational and evidence-informed place to start.

Being told nothing can be done is sometimes accurate. But it is worth ruling out the treatable causes first.