Is somatosensory tinnitus confined to the craniocervical region: Diagnostic pitfalls, manual therapy and safety considerations

Somatosensory tinnitus is tinnitus that is triggered or modulated by somatic input, and current diagnostic criteria locate that input in the cervical spine and temporomandibular region.This minireview, based on a structured narrative search of PubMed (January 2015 to October 2026), grades the evidence for somatic modulation by body region and examines diagnosis, conservative management and safety.Evidence is strongest for the jaw, face and neck, where auditory-somatosensory convergence in the dorsal cochlear nucleus is anatomically established and small randomized trials of cervical and temporomandibular manual therapy report short-term benefit with a high risk of bias.Modulation by limb contractions is documented but preliminary.Evidence for a lumbosacral contribution is indirect, consisting of confounded spinal neuromodulation case reports, a cross-sectional association with low back pain and uncontrolled observations; no anatomical projection has been demonstrated, and no controlled study has tested lumbar-directed treatment for tinnitus.One authormanaged patient, whose tinnitus began with acute lumbosacral pain during use of a percussive massage device, is used only to frame four diagnostic pitfalls; this uncontrolled observation cannot establish causation, a lumbosacral mechanism or a treatment effect, and no recommendation depends on it.We compare manual therapy with guidelines that recommend cognitive behavioural therapy, summarise published massage-device adverse events, which are case reports that cannot establish causation or incidence, outline practical suicide screening tools and recommend validated outcome measures.An expanded somatic examination can be considered when specific history clues are present, but its yield is unknown, and we define research priorities to test it.