What are the benefits of Ginkgo biloba for vertigo and ear-related issues?

Ginkgo Biloba for Vertigo and Ear-Related Issues

Ginkgo biloba is not recommended for treating vertigo, tinnitus, or other ear-related issues due to insufficient evidence of benefit and potential risks. 1

Evidence Against Ginkgo for Ear-Related Conditions

Tinnitus

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) explicitly recommends against using Ginkgo biloba for treating persistent, bothersome tinnitus 1. This recommendation is based on:

• Systematic reviews and randomized controlled trials with methodological concerns
• A preponderance of benefit over harm in avoiding unproven therapy
• Low strength of evidence for any benefit

A 2022 Cochrane systematic review specifically examining Ginkgo biloba for tinnitus concluded that there is significant uncertainty about both benefits and harms when compared to placebo 2. The review found:

• Very low-certainty evidence that Ginkgo may have little to no effect on tinnitus symptom severity
• Low-certainty evidence regarding adverse effects
• Poor quality studies with high risk of bias

Vertigo

For vertigo, particularly in conditions like Benign Paroxysmal Positional Vertigo (BPPV), clinical practice guidelines do not recommend Ginkgo biloba as a treatment option 1. Instead, they recommend specific repositioning procedures and, in some cases, vestibular rehabilitation.

For Ménière's disease, which can cause vertigo, the clinical practice guideline does not include Ginkgo biloba among recommended treatments 1.

For sudden hearing loss with vertigo, the clinical practice guideline specifically advises against using vasodilators including Ginkgo biloba, noting that these therapies have considerable side effects and lack proven efficacy 1.

Alternative Evidence-Based Approaches for Vertigo

For BPPV:

1. Canalith repositioning procedures (strong recommendation) 1
2. Vestibular rehabilitation in selected cases (option) 1
3. Avoidance of vestibular suppressant medications (recommendation against) 1

For Ménière's Disease:

1. Vestibular rehabilitation for chronic imbalance (recommendation) 1
2. Hearing aids and assistive technology for associated hearing loss (recommendation) 1

For Age-Related Vertigo:

While one study suggested that balance training with vibrotactile neurofeedback combined with Ginkgo biloba extract might improve age-related vertigo 3, this single study does not outweigh the recommendations from clinical practice guidelines.

Potential Risks and Drug Interactions

Ginkgo biloba has potential side effects and drug interactions that should be considered:

• At recommended doses (up to 240 mg/day), clinically relevant interactions appear minimal 4
• At higher doses, Ginkgo may:
  • Weakly induce CYP2C19
  • Weakly inhibit CYP3A4
  • Increase bioavailability of certain medications
• Potential adverse effects include bleeding risk, which is particularly concerning in older adults who may be on anticoagulants

Why Some May Still Consider Ginkgo

Some older studies suggested potential benefits:

• A 2002 study claimed improved vestibular compensation when Ginkgo was combined with kinezytherapy 5
• A 2005 study suggested non-inferiority of a homeopathic remedy compared to Ginkgo for atherosclerosis-related vertigo 6

However, these studies have significant methodological limitations and have not been substantiated by higher-quality research or incorporated into clinical practice guidelines.

Conclusion

Based on current clinical practice guidelines and systematic reviews, Ginkgo biloba should not be recommended for vertigo or ear-related issues such as tinnitus. Instead, evidence-based approaches specific to the underlying condition should be utilized, such as canalith repositioning procedures for BPPV, vestibular rehabilitation for chronic imbalance, or cognitive behavioral therapy for tinnitus.