New combo therapy targets ringing ears without drugs

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Age 18-70 years (inclusive) * Chronic subjective tinnitus present for ≥6 months * Tinnitus Handicap Inventory (THI) score ≥18 points (indicating at least mild tinnitus handicap) * Positive somatosensory modulation test: ability to reproducibly modulate tinnitus (change in loudness, pitch, or quality) through at least one of the following manoeuvres: * Jaw movements (mouth opening, lateral excursion, protrusion, clenching) * Neck movements (flexion, extension, rotation, lateral flexion) * Pressure on specific head/neck muscles * Eye movements or shoulder elevation * Willing and able to attend all study sessions over 28 weeks * Adequate cognitive capacity to understand study procedures and complete questionnaires in the Czech language * Signed written informed consent Exclusion Criteria: * Audiological/ENT Exclusions: * Objective or pulsatile tinnitus * Active ear pathology requiring treatment: * Acute otitis media or externa * Chronic suppurative otitis media * Cholesteatoma * Meniere's disease with recent vertigo attacks (\<3 months) * Suspected retrocochlear pathology: * Acoustic neuroma (vestibular schwannoma) * Cerebellopontine angle tumor * Neurological Exclusions: * Neurological disease affecting brainstem or auditory pathways: * Multiple sclerosis with brainstem involvement * Stroke affecting auditory pathways * Brain tumor * Epilepsy or active seizure disorder * Musculoskeletal Exclusions: * Contraindications to manual therapy: * Severe cervical spine instability * Rheumatoid arthritis with atlantoaxial instability * Down syndrome * Vertebrobasilar insufficiency * Severe osteoporosis with fracture risk * Recent cervical spine surgery (\<6 months) * Recent head or neck trauma (\<3 months) * Ongoing physiotherapy or manual therapy for temporomandibular joint or cervical spine (\<3 months prior to enrollment) * Psychiatric Exclusions: * Severe psychiatric disorder: * Active psychosis * Severe depression requiring inpatient treatment * Acute suicidal ideation (PHQ-9 item 9 score ≥2) * Active substance abuse disorder * Other Exclusions: * Pregnancy (due to modifications needed in physical examination and treatment) * Ongoing litigation or compensation claims related to tinnitus or hearing loss * Current participation in another interventional clinical trial * Expected change of residence or long-term absence (\>2 weeks) during the study period * Unable or unwilling to comply with study procedures and attend all sessions