Is Ginkgo biloba (Ginkgo) effective for treating tinnitus?

Ginkgo Biloba is Not Effective for Treating Tinnitus

Clinicians should not recommend Ginkgo biloba for treating patients with persistent, bothersome tinnitus due to lack of proven efficacy and potential side effects. 1, 2, 3

Evidence Against Ginkgo Biloba for Tinnitus

• The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against using Ginkgo biloba for treating persistent, bothersome tinnitus based on randomized controlled trials and systematic reviews with methodological concerns 1
• Current evidence indicates that Ginkgo biloba probably does not decrease the severity of tinnitus, reduce its intensity, or improve quality of life in affected patients 4
• A 2022 Cochrane systematic review found that Ginkgo biloba may have little to no effect on tinnitus symptom severity compared to placebo, with very low certainty of evidence 5
• Pooled data from studies using validated measures like the Tinnitus Handicap Inventory showed no significant difference between Ginkgo biloba and placebo (mean difference -1.35 on a scale of 0-100) 5

Safety Considerations

• While serious adverse effects from Ginkgo biloba appear rare, concerns exist regarding:
  • Potential bleeding risk due to its mild antiplatelet properties 5
  • Variable content and dosage of active ingredients in over-the-counter preparations 1
  • Possible interactions with other medications 2, 3

Methodological Issues in Ginkgo Research

• Studies supporting Ginkgo biloba for tinnitus often suffer from:
  • Poor methodology and high risk of bias 6, 5
  • Inadequate blinding and allocation concealment 5
  • Small sample sizes limiting statistical power 1
  • Strong placebo effect in tinnitus treatment studies 6

Recommended Evidence-Based Approaches for Tinnitus

• Cognitive Behavioral Therapy (CBT) has the strongest evidence base for improving quality of life in patients with persistent, bothersome tinnitus 2, 3
• Hearing aid evaluation is recommended for patients with hearing loss and tinnitus, even if the hearing loss is mild or unilateral 2, 3
• Education and counseling about management strategies should be provided to all patients with persistent, bothersome tinnitus 2, 3
• Sound therapy may provide symptomatic relief for persistent tinnitus 3

Clinical Implications

• Despite some earlier positive reports 7, more rigorous and recent evidence does not support Ginkgo biloba use for tinnitus 4, 5
• The preponderance of evidence shows benefit in avoiding unproven therapies like Ginkgo biloba, preventing false hope, unnecessary expense, and potential side effects 1
• Clinicians should focus on evidence-based approaches like CBT, hearing aids (when appropriate), and education/counseling rather than dietary supplements 2, 3