Is Ginkgo biloba effective for treating tinnitus?

Ginkgo Biloba for Tinnitus: Not Recommended

Ginkgo biloba should not be recommended for treating tinnitus as it likely provides no benefit while potentially exposing patients to unnecessary risks. 1, 2

Evidence Against Ginkgo Biloba for Tinnitus

• The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against using Ginkgo biloba for persistent, bothersome tinnitus (Grade B recommendation based on RCTs and systematic reviews) 1, 2
• Recent systematic reviews indicate that Ginkgo biloba:
  • Probably does not decrease tinnitus severity 3
  • Does not reduce tinnitus intensity 3
  • Does not improve quality of life in tinnitus patients 3
• The 2022 Cochrane review (highest quality evidence) found that Ginkgo biloba may have little to no effect on tinnitus symptom severity compared to placebo 4

Potential Risks and Concerns

• Potential side effects include:
  • Bleeding risk (particularly concerning for patients on anticoagulants) 4
  • Gastrointestinal upset 4
  • Headache 4
  • Allergic reactions 4
• Additional concerns:
  • Inconsistent formulations and dosages across over-the-counter preparations 1
  • Lack of FDA regulation for dietary supplements 1
  • Potential for drug interactions with other medications 5

Evidence Quality Assessment

• The recommendation against Ginkgo biloba is based on Grade B evidence (RCTs with methodological concerns and systematic reviews) 1
• Most positive studies supporting Ginkgo biloba have significant methodological flaws 5:
  • Small sample sizes
  • Poor blinding
  • Inadequate placebo controls
  • Publication bias
• The two most rigorous double-blind, placebo-controlled trials published in peer-reviewed journals showed negative results 5

Recommended Alternatives for Tinnitus Management

Instead of Ginkgo biloba, consider evidence-based approaches:

1. Cognitive Behavioral Therapy (CBT) - strongest evidence base among all interventions 2
2. Sound therapy - provides relief from tinnitus-associated stress 2
3. Hearing aids - recommended for patients with hearing loss and bothersome tinnitus 2
4. Patient education and counseling about tinnitus mechanisms and management strategies 2

Common Pitfalls to Avoid

• Prescribing unproven supplements that may be costly and ineffective 2
• Failing to address psychological aspects of tinnitus management 2
• Neglecting to evaluate and treat hearing loss that often accompanies tinnitus 2
• Using treatments without evidence of benefit that may delay patients from seeking effective therapy 5

While some older or lower-quality studies suggest potential benefits of Ginkgo biloba 6, 7, the most recent and highest-quality evidence clearly indicates that it should not be recommended for tinnitus treatment.