Clinical Question: Does ginkgo biloba improve symptoms of tinnitus?

Setting: Outpatient (any)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: A previous systematic review found cautious support for the use of ginkgo biloba to treat tinnitus, but a subsequent larger trial found no benefit. This updated review synthesizes results from all of the randomized controlled trials (RCTs) to date. These authors also performed their own RCT of 60 patients who were randomized (allocation concealed) to receive sustained-release ginkgo biloba in a dosage of 120 mg or matching placebo. A variety of outcomes were measured using validated measures of tinnitus, with no significant difference seen between groups. The study was powered to detect a 20-point change in the symptom score, which is clinically significant.

The meta-analysis looked at each of the six RCTs on the topic, including the authors’ own, and classified patients as responders or nonresponders on the basis of whatever outcome measure was used in that particular study. They found no statistically significant benefit: 107 patients out of 522 in the ginkgo group and 87 patients out of 504 in the control group (20.5 percent versus 17.3 percent; P = not significant) reported symptomatic improvement.

Bottom Line: There is no evidence from six randomized trials of more than 1,000 patients that ginkgo biloba is an effective therapy for tinnitus. (Level of Evidence: 1a)