Can melatonin be used to treat tinnitus?

Melatonin for Tinnitus Treatment

Melatonin should not be recommended for treating tinnitus due to insufficient evidence of benefit and the potential for side effects. 1

Evidence Against Melatonin for Tinnitus

• The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) specifically recommends against using melatonin for treating persistent, bothersome tinnitus in their clinical practice guidelines 1, 2
• This recommendation is based on randomized controlled trials and systematic reviews that demonstrate a lack of consistent benefit for tinnitus symptoms 1
• The AAO-HNS categorizes this as a "recommendation against" with a preponderance of benefit over harm, meaning the potential risks outweigh any possible benefits 1
• Current tinnitus management guidelines prioritize evidence-based approaches rather than supplements without proven efficacy 2

Recommended First-Line Treatments for Tinnitus

• Cognitive Behavioral Therapy (CBT) is strongly recommended for patients with persistent, bothersome tinnitus as it has the strongest evidence base for improving quality of life 1, 2
• Hearing aid evaluation should be recommended for patients with tinnitus and hearing loss, even if the hearing loss is mild or unilateral 2
• Sound therapy may be considered as a management option for providing symptomatic relief in persistent tinnitus 1, 2
• Patient education and counseling about tinnitus management strategies are essential components of care 2

Why Melatonin Has Been Considered

• Some researchers have hypothesized that melatonin might help tinnitus through:

  • Sleep enhancement properties, as tinnitus often disturbs sleep 3
  • Potential antioxidative properties at high doses, though these are typically at supraphysiologic levels 3
  • Possible vasoactive effects that might improve labyrinthine perfusion 4
  • Potential modulatory effects on the central nervous system 4

• Small studies have reported some benefit when combining melatonin with other agents like sulodexide 5, 6, 7, but these studies have methodological limitations and have not been incorporated into clinical guidelines

Potential Risks and Side Effects

• Common side effects of melatonin include daytime sleepiness, headache, trouble thinking, and nausea 1
• While melatonin is generally considered to have a favorable side effect profile compared to many medications, it is not regulated by the FDA in the United States, leading to inconsistent formulations and dosing 1
• Different melatonin brands may have varying efficacy due to lack of standardization 1

Treatment Algorithm for Tinnitus

1. Perform a comprehensive evaluation to identify any treatable underlying conditions 2
2. Distinguish between bothersome and non-bothersome tinnitus to guide treatment decisions 2
3. For bothersome tinnitus:
   • First-line: Recommend CBT 1, 2
   • For patients with hearing loss: Recommend hearing aid evaluation 2
   • Consider sound therapy for symptomatic relief 1, 2
   • Provide education and counseling about tinnitus management 2
4. Avoid medications without clear evidence of benefit, including melatonin, antidepressants, anticonvulsants, anxiolytics, or intratympanic medications 1, 2

Common Pitfalls to Avoid

• Recommending dietary supplements like melatonin, Ginkgo biloba, or zinc that lack evidence of efficacy 1, 2
• Prescribing medications without clear evidence of benefit that may cause side effects or potentially worsen tinnitus 1, 2
• Overlooking mild hearing loss that could benefit from hearing aid intervention 2
• Failing to address psychological aspects of tinnitus through CBT and counseling 1, 2