10Supplements and Complementary Therapy

FWhy patients try supplements

Faced with a symptom that mainstream medicine cannot switch off, many people with tinnitus turn to the supplement aisle and to complementary practitioners. The appeal is understandable: supplements are sold as ‘natural’, are available without a prescription, and are marketed with confident, hopeful language that the honest clinician cannot match.

The clinician’s task is not to mock this instinct but to engage with it. A patient who feels dismissed will simply buy the product anyway and stop confiding in you. The better path is to discuss what the evidence actually shows, what a product might cost in money and in delayed access to effective care, and what genuine harms — from bleeding to false hope — can follow. The clinical-practice guideline explicitly addresses these agents so that this conversation rests on data rather than opinion [2014].

TGinkgo biloba: the most-studied, still negative

Ginkgo biloba extract, especially the standardised EGb 761, is the supplement most often taken for tinnitus. Its proposed actions — improving cochlear blood flow, scavenging free radicals and modulating neurotransmission — are biologically plausible, which is partly why the hope persists.

The plausibility has not survived rigorous testing. The Cochrane review by Hilton and colleagues, pooling randomised trials of ginkgo against placebo, found no convincing evidence that it improves tinnitus when given to people whose primary complaint is the sound itself [2013]. The updated 2022 Cochrane review reached the same verdict, judging the evidence of no benefit to be of low to moderate certainty [2022]. Ginkgo is not free of risk either: it has antiplatelet activity and can increase bleeding, a real concern in patients also taking anticoagulants or antiplatelet drugs.

TZinc, vitamins and herbal remedies

Zinc is concentrated in the cochlea and modulates glutamatergic synapses, so zinc supplementation has an appealing rationale. A Cochrane review of zinc for tinnitus, however, found no evidence that it improves tinnitus in the general population, with only weak and inconsistent signals in the subgroup of older, zinc-deficient patients [2016]. Excess zinc can disturb copper metabolism and cause gastrointestinal upset, so empirical high-dose use is not benign.

The wider field — magnesium, B-vitamins, melatonin combinations, and a long list of branded herbal blends — suffers from small, unblinded, heterogeneous trials. None has produced the kind of replicated, placebo-controlled effect that would justify routine recommendation. The guideline therefore makes no recommendation for dietary supplements as a treatment for persistent bothersome tinnitus [2014].

CAcupuncture and homeopathy

Among the complementary therapies, acupuncture is the most studied. A meta-analysis of randomised trials found that any apparent benefit shrinks as trial quality improves and that sham-controlled studies do not support a specific therapeutic effect on tinnitus, though the analysis was limited by small, heterogeneous trials [2021]. Homeopathy has no plausible mechanism and no credible evidence of benefit in tinnitus at all.

This does not mean such encounters are inert. A caring, attentive practitioner mobilises a powerful placebo response (the subject of the next module). The ethical issue is honesty: presenting an unproven therapy as a proven cure misleads the patient and can delay access to education, hearing aids and psychological therapy that genuinely help.

CMelatonin: a modest, defensible niche

Melatonin stands slightly apart. It is not a tinnitus cure, but several small randomised trials suggest it can improve sleep and, secondarily, tinnitus-related distress in patients whose main problem is disturbed sleep. A randomised trial comparing melatonin with sertraline reported improvement in tinnitus scores in both arms [2017], and an earlier randomised study found melatonin helpful particularly in patients with sleep difficulty and more severe tinnitus [2011].

The honest framing is that melatonin’s benefit is mediated through sleep rather than through the tinnitus signal — a theme picked up in the comorbidities module. It is cheap, well tolerated and short-term-safe, which makes a time-limited trial reasonable for the poor-sleeping patient, provided expectations are set carefully and the ‘cure’ language of the supplement market is avoided [2013].