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Ginkgo for tinnitus



Clinical bottom line: Small, methodologically weak studies showed mostly positive beneficial effects of ginkgo on tinnitus.


Systematic review:

Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol 1999; 24: 164-167.



Date review completed: 1998

Number of trials included: 5

Number of patients: (601 total)

Control groups: placebo, active treatment

Main outcomes: Severity score (0-3), patient preference, loudness of tinnitus, specialist evaluation.

Inclusion criteria were randomised controlled trial which assessed ginkgo biloba in patients with tinnitus. Homeopathic dilutions of ginkgo were excluded.

Medline, Embase and the Cochrane Library were searched (to June 1998) for published reports. The reviewers' own databases were also searched. Bibliographies of retrieved reports were checked for additional citations and no language restrictions were made. Manufacturers of gingko preparations were contacted for published and unpublished information. Data were extracted in a standardised, predefined manner by the two reviewers. A descriptive analysis was conducted.


Findings:

One randomised, double blind trial assessed ginkgo biloba extract 4 ml per day or placebo over 1-3 months in 103 patients with clinical tinnitus. The severity of tinnitus symptoms was assessed, though details of the criteria for evaluation were unclear. Improvement was significantly greater and faster with ginkgo than with placebo.

One trial assessed 99 patients with chronic tinnitus. All were initially treated with three placebo tablets per day for two weeks, after which patients were randomised to ginkgo 120 mg daily or placebo for 12 weeks in a double blind manner. Loudness of tinnitus was significantly improved in patients treated with ginkgo than with placebo.

One trial assessed daily injections of ginkgo 200 mg over 10 days in 60 patients with chronic tinnitus. The first treatment phase was not blind. In the second treatment phase patients were randomised to receive oral ginkgo 80 mg compared with placebo for three months. A reduction in loudness of tinnitus in the worst affected ear was reported in both the open and double blind treatment phases; the difference between ginkgo and placebo was significantly different.


Adverse effects

Adverse effects were not mentioned.

 

Comment

The other studies included in this systematic review are worthy of mention only because they were so poor. The methodology used was seriously flawed. One study which was described as a randomised trial was not randomised, because patients were allocated to treatment group according to the day of the week. No mention of blinding was made and the duration of treatment was described as being at least one month; no further details were provided. Another trial assessed the effects of gingko in an uncontrolled open treatment phase, followed by a double blind treatment phase in patients who had a positive response to ginkgo in the open phase. This is a bias in the study design.

None of the included trials were without methodological flaws, though the three studies of highest quality all showed beneficial effects with ginkgo. All of the studies were small (the total number assessed was 266 patients). They assessed different doses and formulations (tablet, drops, injection) of ginkgo, different severity of disease, and were of different treatment duration.


Further reading


Related topics


Identifier

AT124 - 5915 GINKGO FOR TINNITUS: Aug-2000