• Ears (Ringing)
Principal Proposed Natural Treatments
Other Proposed Natural Treatments
• Acupuncture; Biofeedback; Coenzyme Q 10; Glutamic Acid; Hypnosis; Ipriflavone; Massage; Magnet Therapy; Melatonin; Oxerutins; Periwinkle; Vitamin A Combined With Vitamin E; Vitamin B 12; Zinc
Probably Not Effective Treatments
• Ginkgo biloba
Tinnitus aurium is the technical term for ringing in the ear, although it may actually involve sounds better described as buzzing, roaring, or hissing. The noise can be intermittent or continuous and can vary in pitch and loudness. Most people have experienced tinnitus occasionally for a minute or two. However, some people have tinnitus continuously, over long periods of time. It can range from a minor annoyance to a serious and nearly intolerable condition.
Exposure to loud noise can lead to tinnitus, as can ear obstructions, ear infections , otosclerosis (abnormal bone growth in the ear), head injuries, or heart and blood vessel disorders. In some cases, treating the underlying disorder will relieve the tinnitus. However, in many cases, the cause can neither be found nor treated.
One approach involves covering up the noise to make it more tolerable. This includes using hearing aids or tinnitus maskers (devices worn in the ear that emit pleasant sounds), or simply playing music to cover the noise. Avoiding loud noises, nicotine, aspirin, caffeine, and alcohol may help, since these often aggravate tinnitus.
Drugs such as carbamazepine, benzodiazepines, and tricyclic antidepressants may be tried, although none of these have been proven effective for tinnitus.
Proposed Natural Treatments
There are no well-documented natural treatments for tinnitus.
Several studies have evaluated Ginkgo biloba extract for treating tinnitus, but the results have been conflicting. 2-7,18 While some small studies found benefit, the largest and best-designed of these trials found no benefit. In this double-blind, placebo-controlled trial, 1,121 individuals with tinnitus were given 12 weeks of treatment with standardized ginkgo at a dose of 50 mg 3 times daily. 8 The results showed no difference between the treated and the placebo group.
A separate set of researchers performed an additional study on ginkgo for tinnitus, and then additionally conducted a meta-analysis (statistically rigorous review) of the published data. Their conclusion: The evidence is strong enough to state that ginkgo does not benefit tinnitus. 20
One double-blind, placebo-controlled study found that zinc deficiency was common in people with tinnitus. 21 Zinc supplements appeared to help, but the study was too small to provide statistically meaningful results. In contrast, another small double-blind, placebo-controlled study of people with tinnitus did not discover frequent zinc deficiency and failed to find any benefit with zinc supplements. 12
Vitamins A and E in combination, vitamin B 12 , glutamic acid, ipriflavone , oxerutins , and periwinkle have also been suggested for the treatment of tinnitus, but as yet the supporting evidence for their use remains far too weak to rely upon. 9-10,13-15
Repetitive transcranial magnetic stimulation (rTMS) is a specialized type of magnet therapy that has been studied as a possible treatment for tinnitus. However, a review of 5 randomized trials comparing real rTMS to sham rTMS in 233 people with tinnitus found limited evidence to support its use for this indication. 24 The authors highlighted the need for more studies with larger sample sizes.
Several studies of acupuncture for tinnitus failed to find benefit. 1,11,23 In fact, acupuncture was found to be ineffective as treatment for tinnitus symptoms in a review of 13 low-quality randomized trials with 616 patients. Only one of two open trials showed long-term improvement. 25
For a discussion of homeopathic approaches to tinnitus, see the Homeopathy database.
1. Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope . 1999;109:1202-1211.
2. Holgers KM, Axelsson A, Pringle I. Ginkgo biloba extract for the treatment of tinnitus. Audiology . 1994;33:85-92.
3. Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol . 1999;24:164-167.
4. Coles R. Trial of an extract of Ginkgo biloba (EGB) for tinnitus and hearing loss [letter]. Clin Otolaryngol . 1988;13:501-502.
5. Meyer B. Multicenter randomized double-blind drug vs. placebo study of the treatment of tinnitus with Ginkgo biloba extract [translated from French]. Presse Med . 1986;15:1562-1564.
6. Morgenstern C, Biermann E. Long-term tinnitus therapy with ginkgo special extract EGb 761 [translated from German]. Fortschr Med . 1997;115:57-58.
7. Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. BMJ . 2001;322:1-6.
8. Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. BMJ . 2001;322:1-6.
9. Shemesh Z, Attias J, Ornan M, et al. Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss. Am J Otolaryngol . 1993;14:94-99.
10. Romeo G, Giorgetti M. Therapeutic effects of vitamin A associated with vitamin E in perceptual hearing loss [translated from Italian]. Acta Vitaminol Enzymol . 1985;7:139-143.
11. Andersson G, Lyttkens L. Acupuncture for tinnitus: time to stop? Scand Audiol . 1996;25:273-275.
12. Paaske PB, Pedersen CB, Kjems G, et al. Zinc in the management of tinnitus. Placebo-controlled trial. Ann Otol Rhinol Laryngol . 1991;100:647-649.
13. Ehrenberger K, Brix R. Glutamic acid and glutamic acid diethylester in tinnitus treatment. Acta Otolaryngol (Stockh). 1983;95:599-605.
14. Sziklai I, Komora V, Ribari O. Double-blind study on the effectiveness of a bioflavonoid in the control of tinnitus in otosclerosis. Acta Chir Hung . 1992-1993;33:101-107.
15. Moser M, Ranacher G, Wilmot TJ, et al. A double-blind clinical trial of hydroxyethylrutosides in Meniere's disease. J Laryngol Otol . 1984;98:265-272.
16. Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope . 1999;109:1202-1211.
17. Rosenberg SI, Silverstein H, Rowan PT, et al. Effect of melatonin on tinnitus. Laryngoscope . 1998;108:305-310.
18. Morgenstern C, Biermann E. The efficacy of Ginkgo special extract EGb 761 in patients with tinnitus. Int J Clin Pharmacol Ther. 2002;40:188-197.
19. Arda HN, Tuncel U, Akdogan O, et al. The role of zinc in the treatment of tinnitus. Otol Neurotol . 2003;24:86-89.
20. Rejali D, Sivakumar A, Balaji N. Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials. Clin Otolaryngol . 2004;29:226-31.
21. Arda HN, Tuncel U, Akdogan O, et al. The role of zinc in the treatment of tinnitus. Otol Neurotol . 2003;24:86-89.
22. Khan M, Gross J, Haupt H, et al. A pilot clinical trial of the effects of coenzyme Q 10 on chronic tinnitus aurium. Otolaryngol Head Neck Surg . 2007;136:72-77.
23. Wang K, Bugge J, Bugge S. A randomised, placebo-controlled trial of manual and electrical acupuncture for the treatment of tinnitus. Complement Ther Med. 2010;18(6):249-255.
24. Meng Z, Liu S, Zheng Y, Phillips JS. Repetitive transcranial magnetic stimulation for tinnitus. Cochrane Database Syst Rev. 2011;(10):CD007946.
25. Park J, White AR, Ernst E. Efficacy of acupuncture as a treatment for tinnitus: a systematic review. Arch Otolaryngol Head Surg . 2000;126(4):489-492.
Last reviewed August 2013 by EBSCO CAM Review Board
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