Q&A

Ginkgo ineffective for tinnitus

J Fam Pract. 2003 October;52(10):747-769
By
Michael DeBisschop, PharmD
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  • BACKGROUND: There is no definitive pharmacological treatment for tinnitus. A wide variety of drugs— including alprazolam, antiarrhythmics, antihistamines, baclofen, tricyclic antidepressants, lamotrigine, melatonin, misoprostol, niacin, and zinc—have been investigated, mostly in small trials, but none has established itself as particularly effective. Because of its effects on cognition, memory, and cerebral blood flow, Ginkgo biloba has been repeatedly investigated for this condition.
  • POPULATION STUDIED: This meta-analysis included a total of 541 patients in 5 different studies with chronic or severe persistent tinnitus. No other information about the patients is available.
  • STUDY DESIGN AND VALIDITY: The authors conducted a comprehensive literature search on the topic; they also asked ginkgo manufacturers for any unpublished data. Included trials were controlled (comparator or placebo), performed with Ginkgo biloba as a single therapy, and used subjects with a primary complaint of tinnitus or sudden hearing loss.
  • OUTCOMES MEASURED: Measured outcomes were different among the 5 studies in the meta-analysis. Outcomes included severity score, specialist evaluation, patient preference, and audiometry. Adverse effects were not reported.
  • RESULTS: Of the 5 studies, 4 showed a beneficial effect of ginkgo extract, 120–160 mg/d, on their outcome measures of chronic tinnitus. The 1 negative study used a subtherapeutic dose of ginkgo. Methodological quality varied— 2 of the positive studies had low Jadad scores (0 and 2 on a scale of 1 to 5, with 5 being best), 2 studies had high scores (4 and 5), and 1 study was not evaluable since it was published in abstract form only.
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PRACTICE RECOMMENDATIONS

Although the results of published trials are inconsistent, Ginkgo biloba is probably not effective for the treatment of tinnitus. Positive results of earlier small studies with serious methodological limitations are not supported by larger, more rigorous trials. However, the lack of any established pharmacological treatment for chronic tinnitus, combined with ginkgo’s excellent safety profile, make it an option for patients who desire to try it.

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