Sydney Tinnitus Clinic at Vantage Point
Tinnitus Physiotherapy in Bondi Junction
Tinnitus is processed in the brain, but the neck and jaw can turn the volume up. We assess whether yours are part of the picture, and give you a clear plan from there.
- APA Titled Musculoskeletal Physiotherapists
- Objective outcome measures
- No referral needed
- Private health rebates available
Self-check
Could your neck or jaw be part of your tinnitus?
Tinnitus is the perception of sound, such as ringing, hissing, buzzing or humming, with no external source. For some people, the neck and jaw influence how loud or intrusive it is. This is called somatic tinnitus, and these four questions can help you recognise it.
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Does the sound rise and fall with your neck or jaw pain?
When your neck or jaw flares up, does your tinnitus get louder, then settle as the pain settles? Tinnitus and pain changing together is one of the clearest signs of a physical component.
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Are the muscles at the base of your skull tight or tender?
The small suboccipital muscles link the top of your neck to your skull. Their nerve supply comes from the upper neck levels that connect with the brainstem's hearing relay, so tension here matters.
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Does the sound change when you move your jaw or neck?
A change in pitch or loudness with movement or pressure is called somatic modulation.
Try it: gently clench your teeth for five seconds, then press your forehead into your palm. Did the sound change?
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Do you clench or grind your teeth?
Daytime clenching or night-time grinding (bruxism) keeps the jaw muscles working when they should be resting. Signs include a tired or sore jaw in the morning, or catching yourself clenching when focused or stressed.
Answered yes to one or more?
These questions are adapted from the Rapid Screening for Somatosensory Tinnitus tool, developed by Michiels and colleagues (2022) from international diagnostic criteria. A yes doesn't confirm a diagnosis, but it's a good reason to have your neck and jaw properly assessed.
The mechanism
Why the neck and jaw affect what you hear
Sound signals from the inner ear pass first through a relay station in the brainstem called the dorsal cochlear nucleus. This structure also receives direct input from the nerves of the upper neck (C1 to C3) and the trigeminal nerve, which supplies the jaw and face. It uses that input to filter out body sounds such as chewing or head movement.
When hearing is altered by noise exposure or age, research by Susan Shore and colleagues shows this relay station becomes more excitable and relies more heavily on neck and jaw input.
Work by Robert Levine (1999) established that most people with tinnitus can alter the sound through head, neck or jaw manoeuvres. This is why physical findings in the neck and jaw remain relevant, even if your tinnitus began after a hearing issue.
Where physiotherapy fits
How physiotherapy can help
If your neck or jaw is adding signal to the hearing relay, the aim of treatment is to reduce that input and settle a sensitised system. We focus on three areas. The inner ear itself is managed by your audiologist and ENT, and we work alongside them.
The upper neck
C1 to C3 joints and muscles
What we look for
Stiff or irritable upper neck joints, tender suboccipital muscles, and reduced deep neck flexor control.
What we do
Gentle joint mobilisation, soft tissue work to the suboccipital muscles, and deep neck flexor retraining.
The jaw
Jaw joint (TMJ) and chewing muscles
What we look for
Clicking or restricted opening, overactive masseter and temporalis muscles, and clenching or grinding.
What we do
Jaw mobilisation, soft tissue release, dry needling where indicated, and practical strategies to reduce clenching.
The nervous system
How sensitised the hearing relay has become
What we look for
Poor sleep, high stress and heightened sound sensitivity, which keep the system on high alert.
What we do
Clear education on the mechanism, down-regulation and sleep strategies, and coordination with your psychologist and audiologist.
Progress is measured, not assumed. Your somatic modulation, neck and jaw findings, and Tinnitus Functional Index are re-tested at review, so change is tracked against your baseline.
What to expect
Your initial consultation
A 45-minute assessment designed to find out what is driving your symptoms, not just to describe them.
Bring with you
- Any audiology reports or hearing tests
- ENT or GP letters
- A list of your current medications
- Notes on when your tinnitus started and what makes it better or worse
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Your story
When your tinnitus started, what changes it, and how it affects your sleep, concentration and mood. We also review any audiology or ENT reports.
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Baseline measures
The Tinnitus Functional Index and ratings of loudness and distress, so progress can be measured against where you started.
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Can we modulate your tinnitus?
We use specific jaw and neck movements, and pressure on key structures, to see whether we can change the loudness or pitch of your tinnitus. If we can, it tells us your neck or jaw is part of the picture. If we can't on the day, that doesn't rule it out. Modulation can vary with symptoms, sleep and stress, so we weigh it alongside your history and the other findings.
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Neck assessment
We measure how well your upper neck turns, how well your deep neck muscles control and support it, and how sensitive the joints and muscles are. Your results are compared with normative values from published research, so we can see objectively how your neck compares with what is typical.
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Jaw assessment
We measure jaw opening and movement against research-based normal ranges, check for clicking or deviation, and assess sensitivity in the chewing muscles such as the masseter and temporalis.
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Your plan
A clear explanation of what we found and how it links to your symptoms, a management plan, and a written summary for your GP, audiologist, ENT or psychologist.
How we manage tinnitus
Our four-phase management framework
Tinnitus management isn't linear. Symptoms naturally fluctuate, and phases can overlap or be revisited. Each phase has clear markers to guide when you are ready to progress.
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Phase 1
Down-regulation
Settle local irritability.
We reduce irritability in the upper neck and jaw using gentle joint mobilisation, soft tissue techniques and dry needling where indicated. You also learn practical strategies to calm a sensitised nervous system.
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Phase 2
Motor control
Re-establish deep control.
We retrain deep neck flexor activation and jaw control to reduce ongoing load on the upper neck and jaw joint.
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Phase 3
Load and integration
Build tolerance for everyday life.
We progressively build tolerance for desk work, exercise and noisier environments, alongside any sound therapy from your audiologist.
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Phase 4
Maintenance
Keep the gains.
An individualised self-management plan to recognise early triggers and manage fluctuations independently, because research shows gains can fade once a program ends.
A fluctuation can mean stepping back a phase. That's an expected part of management, not a failure, and your plan adjusts to it.
How many sessions does the research use?
The two main physiotherapy trials in somatic tinnitus ran structured programs over six to nine weeks.
12 sessions over 6 weeks
Neck-related tinnitus
53% of participants reported substantial improvement by the end of the program, and 24% maintained it at six-week follow-up. Michiels et al., 2016
Up to 18 over 9 weeks
Jaw-related tinnitus
A clinically relevant improvement in tinnitus severity in 61% of participants, as part of a multidisciplinary program. van der Wal et al., 2020
Your plan is built around your own findings and reviewed against your baseline measures, so you may need more or fewer sessions than this.
The evidence
What the research says
Two questions matter most when you are deciding on care: who tends to improve with physiotherapy, and who else should be part of your plan.
Who tends to do well
Neck-related tinnitus
Tinnitus and neck pain that move together
People whose tinnitus and neck pain rose and fell together were the most likely to improve. Low-pitched tinnitus that worsened with sustained or awkward postures was also linked to better outcomes.
Michiels et al., 2017
Jaw-related tinnitus
Shorter duration and a tender jaw
A shorter history of tinnitus, more physical symptoms such as head and neck tension, and a tender jaw joint were linked to better outcomes.
van der Wal et al., 2020
What didn't predict it
Movement alone isn't the whole story
Being able to change your tinnitus with movement did not predict who improved, and neither did how stiff the neck was. That's why we weigh your whole history, not a single test.
Michiels et al., 2017; van der Wal et al., 2020
These are group findings, not guarantees. They help us set realistic expectations with you from your first session.
Why a team approach matters
Tinnitus rarely has a single cause, so it rarely has a single solution. The European multidisciplinary guideline for tinnitus (Cima et al., 2019) strongly supports CBT for tinnitus distress, and guidelines consistently recommend hearing aids where there is hearing loss.
In both physiotherapy trials, participants were first assessed by a multidisciplinary team. In the jaw trial, that team included ENT specialists, dentists, physiotherapists and audiologists. Physiotherapy works best as one part of that team, not a replacement for it.
GP and ENT
Rule out medical causes and oversee your overall care.
Audiologist
Hearing assessment, hearing aids where needed, and sound therapy for sound sensitivity.
Psychologist
CBT for tinnitus distress, sleep and anxiety.
Dentist
Splints and dental management for clenching and grinding.
Our role
Physiotherapist
Assessment and management of the neck, jaw and nervous system contributors.
Fees
Clear, upfront fees
Every session is with an APA Titled Musculoskeletal Physiotherapist. Private health rebates depend on your level of extras cover.
Start here
Initial consultation
$275
45-minute assessment
- Detailed history and review of your reports
- Baseline measures, including the Tinnitus Functional Index
- Neck, jaw and modulation assessment
- Your management plan
- A written report to your allied health and medical team
Follow-up session
$235
Per session
- Hands-on management and exercise progression
- Progress reviewed against your baseline
- Updated self-management strategies
Also managed
Related conditions
Our team also assesses and manages these head, neck and jaw conditions.
- Tensor Tympani Syndrome
- Trigeminal neuralgia
- Occipital neuralgia
- Cervicogenic headache
- Whiplash associated disorder
- TMJ disorders
Medicare, workers compensation and CTP. Medicare rebates may apply with a GP chronic condition management plan. Workers compensation and CTP claims are accepted once approved, with fees set by SIRA.
Questions
Frequently asked questions
Can't see your question? Our team is happy to talk it through on (02) 8528 2985.
Do I need a referral?
No. You can book directly. If you have any audiology or ENT reports, please bring them to your first session.
Can physiotherapy cure my tinnitus?
We can't promise that, and we'll always be honest with you about it. Our aim is to identify and reduce the neck, jaw and nervous system factors that amplify your tinnitus, and to give you a clear understanding and plan for managing it. How much change is possible varies from person to person.
How do I know if my tinnitus is somatic?
The self-check on this page is a good start. Signs include tinnitus that rises and falls with neck or jaw pain, changes with movement, or sits alongside clenching and grinding. A thorough assessment confirms it, and being unable to change your tinnitus with movement doesn't rule it out.
How many sessions will I need?
It depends on your findings. The main physiotherapy trials used 12 sessions over 6 weeks for neck-related tinnitus and up to 18 over 9 weeks for jaw-related tinnitus. Your plan is reviewed against your baseline measures, so you may need more or fewer.
Should I see an audiologist or ENT first?
We recommend a hearing assessment if you haven't had one. Please see your GP or an ENT urgently, before physiotherapy, if you have sudden hearing loss in one ear (seek same-day review), tinnitus that pulses with your heartbeat, new tinnitus in one ear with dizziness, facial weakness or numbness, or tinnitus after a head injury.
Can you help with hyperacusis or sound sensitivity?
Physiotherapy addresses the neck, jaw and nervous system factors that can heighten sound sensitivity. Sound therapy is provided by your audiologist, and we coordinate with them so both parts of your care work together.
What if my tinnitus isn't coming from my neck or jaw?
Then we'll tell you. You'll leave with a clear explanation of what we found and a recommendation for your next step, whether that's audiology, ENT, psychology or your GP. We send a written report so you don't have to start from scratch.
What about fees, insurance and claims?
Our fees are listed above. Sessions are billed as physiotherapy consultations, so private health extras rebates apply depending on your level of cover. If your GP has referred you under a chronic condition management plan, you may be eligible for a Medicare rebate on some sessions. We also accept workers compensation and CTP claims once your claim has been accepted, with fees set by SIRA.
Sydney Tinnitus Clinic at Vantage Point
Get a clearer picture of your tinnitus
If your tinnitus changes with jaw or neck movement, a thorough assessment is a good place to start. You'll leave with a clear explanation and a plan, whatever we find.
Location
80 Bronte Road, Bondi Junction NSW 2022
Hours
Mon to Thu 8am to 6pm
Fri 8am to 5pm
Getting started
No referral needed