Methods, Applications, and Limitations of Somatic Maneuvers for the Modulation of Tinnitus
Round 1
Reviewer 1 Report
This review studied a clinically relevant subject in tinnitus research. They have looked at somatic maneuvers for the modulation of tinnitus in literature to find support for the clinical use of these maneuvers.
The authors had a clear objective with an appropriate research design. They performed a literature search with terms related to somatic tinnitus. The selected articles were classified into four groups (jaw, head and neck, eye, and limb). This selection seems relevant and clinical applicable. The chosen somatic maneuvers are well presented in a structured way.
The clinical use of somatic maneuvers for the modulation of tinnitus is divided in two subjects: as screening for somatic tinnitus and as therapy. The screening part is well discussed with special attention to the limitations. Interesting is the section of the discussion looking at the use of somatic maneuvers as therapy for tinnitus. It is a relative unknown therapy with potential. Besides direct treatment of somatic disorders also training with repeated somatic maneuvers for the modulation of tinnitus can be helpful and follow-up studies are advocated. This conclusion is good supported by the presented literature.
I recommend this article for publication as it is an original idea that is worked out well. The study has an appropriate research design, presents the somatic maneuvers for the modulation of tinnitus in a structured way, and is well discussed with a solid conclusion.
Author Response
Response: We really appreciate for your thoughtful comments. We hope that this review will help researchers interested in somatic tinnitus to understand the methods of somatic maneuvers and major research results so far.
Revised: No changes.
Reviewer 2 Report
The proposed paper seems well written and well organized. However, seems unclear the reason why only papers published in English have been included.
In order to truly fulfill the proposed scope, a section that provides background information of the etiology of somatic tinnitus, will give a better undertanding of the topic to audiologists with no expertise in tinnitus assessment and rehabilitation as well as those practitioners, such as Speech & Language and Physio therapists, working with patients affected by TMDs or neck dysfunctions.
Comments for author File: 
Comments.docx
Author Response
Reviewer 2 comments
Comment 1
The proposed paper seems well written and well organized. However, seems unclear the reason why only papers published in English have been included.
Response: We decided to review only the studies published in English for two reasons. The first reason is that all internationally renowned journals, including the SCI indexed journal, are published in English. Second, all the researchers who authored this review were concerned about misinterpretation of papers published in other languages, as English is the only non-native language common to the researchers. To reflect your comments, we have described in the manuscript why we only reviewed articles published in English. We hope our revisions will help you and the readers to better understand this review. Thank you.
Revised (Bold): A flowchart of the article selection procedure is shown in Figure 1. We searched Google Scholar for relevant articles using the following keywords: "somatic tinnitus,” "somatic tinnitus maneuver,” "somatic tinnitus treatment,” "somatic tinnitus disorder,” and "somatic modulation." The search identified a total of 2,863 articles, and 416 articles remained after excluding 2,447 duplicates. Of the 416 articles, 396 that were not related to the topic of this review, non-English articles, animal studies, and non-full-text articles were excluded. We reviewed only the studies published in English, as this was the only non-native language common to all researchers, and we were concerned about misinterpreting papers published in other languages. Finally, 20 articles were selected for this review. Among them, 13 were reviewed for somatic maneuver methods, and 12 were reviewed for applications and limitations. Five articles were reviewed for both types of content.
Comment 2
In order to truly fulfill the proposed scope, a section that provides background information of the etiology of somatic tinnitus, will give a better understanding of the topic to audiologists with no expertise in tinnitus assessment and rehabilitation as well as those practitioners, such as Speech & Language and Physio therapists, working with patients affected by TMDs or neck dysfunctions.
Response: While we fully agree with your comment, the definitive etiology of somatic tinnitus is not clear as only a few studies have attempted to address this issue. Nevertheless, your comment is very important. Therefore, we have added a description of the research needs regarding the etiology of somatic tinnitus in the Conclusion. We really appreciate your comment.
Revised (Bold): Currently, the etiology of somatic tinnitus seems unclear. Some studies have reported that diseases such as TMDs, cervical spine dis-order, Paget's disease of the bone, and restless legs syndrome are mainly accompanied by somatic tinnitus, but more studies are needed to confirm the relationship between these diseases and somatic tinnitus [17,33-35]. This study reviewed the methods, applications, and limitations of somatic maneuvers for assessing modulation of tinnitus during movement or application of pressure. Although some studies have shown that somatic maneuvers can aid in screening for somatic tinnitus and may help to alleviate symptoms with repeated practice, the limited number of studies and inconsistent results among studies make it difficult to draw definitive conclusions. Therefore, follow-up studies are required to overcome these limitations and to determine whether treatment of somatic disorders can also aid in alleviating somatic tinnitus.
- Björne, A. Assessment of temporomandibular and cervical spine disorders in tinnitus patients. Prog. Brain Res. 2007, 166, 215–219.
- Mackenzie, I.; Young, C.; Fraser, W. D. Tinnitus and Paget's disease of bone. J. Laryngol. Otol. 2006, 120, 899–902.
- Chen, P. K.; Fuh, J. L.; Chen, S. P.; Wang, S. J. Association between restless legs syndrome and migraine. J. Neurol. Neu-rosurg. Psychiatry 2010, 81, 524–528.
