Does Ginkgo Biloba Work for Tinnitus?
Ginkgo biloba is the most widely studied herbal supplement for tinnitus, but a 2022 Cochrane review of 12 randomised controlled trials with 1,915 participants found little to no effect compared to placebo (Sereda et al., 2022). Clinical guidelines from the US, Europe, and Germany explicitly recommend against it. The rest of this article explains why some studies appear to contradict that finding, what the safety concerns are, and where the evidence actually points for tinnitus relief.
Why So Many Tinnitus Patients Try Ginkgo
When you have tried everything your doctor suggested and the ringing is still there, it is natural to look elsewhere. Ginkgo biloba sits at the top of that list for a lot of people: it is inexpensive, available without a prescription, and has been sold for decades as a supplement for circulation and memory. If tinnitus sometimes has a vascular component, the reasoning goes, perhaps something that improves blood flow might help.
You are not the only one who has followed that logic. Ginkgo is the single most commonly reported supplement among tinnitus patients globally, cited by 26.6% of supplement users in a large 53-country survey (attributed to Coelho et al., 2016). Patient organisations including Tinnitus UK acknowledge the appeal directly while being clear that the clinical evidence does not support it.
If you have already bought a bottle, or are considering it, that impulse is understandable. This article is not here to dismiss the question. It is here to show you what the evidence actually says, clearly and without the spin in either direction.
What the Best Evidence Says About Ginkgo Tinnitus Research
A Cochrane review is a pooled analysis of the best available randomised controlled trials on a given question. When several trials are combined, the statistical power to detect a real effect increases, and the conclusions are more reliable than any single study.
The 2022 Cochrane review on ginkgo biloba for tinnitus included 12 randomised controlled trials with 1,915 participants. Researchers measured tinnitus symptom severity using the Tinnitus Handicap Inventory (THI), a validated scale running from 0 to 100. The pooled difference between ginkgo and placebo was a mean reduction of just 1.35 points on a 100-point scale (95% CI: -8.26 to 5.55). That range crosses zero, meaning the data are consistent with no effect at all. The review’s conclusion: ginkgo biloba has “little to no effect” on tinnitus (Sereda et al., 2022).
The evidence certainty was rated low to very low, mainly because most included trials had unclear risk of bias or poor blinding methodology. This is worth understanding carefully: low certainty does not mean the finding is probably wrong. It means the data quality limits how confident we can be. But the direction of evidence across all 12 trials was consistently null, and that consistency matters.
The largest single trial in this field reinforces the picture. The Drew and Davies BMJ study enrolled 1,121 people and compared 150 mg of ginkgo extract daily against placebo over 12 weeks in 978 matched pairs. Using both a loudness scale and a troublesomeness scale, the result was the same: “no significant difference between the two groups on any of the outcome measures” (Drew and Davies, 2001).
An independent GRADE synthesis published in 2018 reached the same conclusion across four RCTs, rating the evidence as “moderate certainty” that ginkgo probably does not decrease tinnitus severity (Kramer-Ortigoza, 2018). A 2004 meta-analysis of six double-blind RCTs (n=1,056) found an odds ratio of 1.24 (95% CI: 0.89 to 1.71), which is not statistically significant, and concluded simply: “Ginkgo biloba does not benefit patients with tinnitus” (Rejali et al., 2004).
That is a consistent null finding across independent evidence syntheses spanning more than twenty years.
Why Some Studies Seem to Show It Works
If ginkgo does not work, why do positive studies exist? There are three reasons, and understanding them is what separates a careful reading of the evidence from a misleading one.
1. Small trials give unreliable signals
Many of the positive results in the literature came from studies involving 20 to 70 participants. Trials this small are underpowered: they cannot reliably distinguish a real treatment effect from random variation. The 2023 trial by Chauhan et al. is a recent example. It enrolled 69 participants across three arms (placebo, ginkgo alone, and ginkgo plus antioxidants) and found that THI scores improved from moderate to mild in the ginkgo groups. The authors concluded the combination was effective.
But the limitations are significant: roughly 22 to 24 participants per arm, no antioxidant-only arm (so any benefit cannot be attributed to ginkgo specifically), unclear blinding methodology, and a single-centre unregistered trial. A small positive result from one underpowered trial cannot override a pooled analysis of 1,915 participants (Chauhan et al., 2023). When small positive trials are added into the Cochrane pool, the signal disappears.
2. Manufacturer funding and the EGb 761 question
Some proponents argue that the standardised extract EGb 761 (sold as Tebonin in Germany and Tanakan in France) is meaningfully different from other ginkgo preparations, and that positive trials used EGb 761 while null trials used inferior extracts. There is a specific preparation called LI 1370 used in the Drew and Davies trial, which EGb 761 advocates cite as a methodological distinction.
The Cochrane reviewers considered this argument. Their conclusion was that even pooling trials that used EGb 761 specifically showed no benefit for primary tinnitus (Sereda et al., 2022). A relevant detail: the meta-analysis most often cited as evidence for EGb 761’s benefits in tinnitus was co-authored by a researcher affiliated with Dr. Willmar Schwabe GmbH, the manufacturer of EGb 761 (Spiegel et al., 2018). Conflict-of-interest concerns do not invalidate a study, but they do warrant scrutiny.
3. Tinnitus in dementia patients is a different condition
This is the most important distinction the promotional literature rarely explains. A 2018 meta-analysis found that EGb 761 did reduce tinnitus severity in elderly patients with dementia (Spiegel et al., 2018). This finding is real. The problem is that tinnitus in dementia patients arises through a different mechanism: cognitive-perceptual disruption and vascular dysregulation in the central nervous system. Primary idiopathic tinnitus (the ringing that most people reading this article experience) has a different neurological basis. A treatment that helps one condition does not automatically help the other, and treating these two populations as interchangeable is a methodological error that inflates the apparent evidence for ginkgo.
The Safety Question: Ginkgo Is Not Risk-Free
Even if ginkgo were simply ineffective, the decision to take it might seem low-stakes. It is not.
Ginkgo biloba inhibits platelet-activating factor, a mechanism that reduces the blood’s clotting ability. A systematic review of 149 articles covering 78 herbal supplements documented a clinically meaningful interaction between ginkgo and warfarin, with reported bleeding events ranging from minor (gum bleeding, bruising) to major, including intracranial haemorrhage (Tan and Lee, 2021). The interaction extends to antiplatelet drugs such as aspirin and clopidogrel, and to NSAIDs including ibuprofen.
This is not a theoretical concern. The tinnitus population skews older, and older adults are disproportionately likely to be on cardiovascular medications. If you are taking a blood thinner for atrial fibrillation, a stent, or any other cardiovascular reason, ginkgo may meaningfully increase your bleeding risk.
Clinical guidance recommends stopping ginkgo at least two weeks before any elective surgery, precisely because of this platelet-inhibiting mechanism.
Talk to your doctor before taking ginkgo biloba, especially if you are on any anticoagulant, antiplatelet, or anti-inflammatory medication.
What the Guidelines Say
The clinical guideline picture is unusually consistent for a supplement question.
The AAO-HNS Clinical Practice Guideline on Tinnitus (the primary US guideline) states explicitly that clinicians “should not recommend Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus” (Tunkel et al., 2014). The strength of recommendation is Grade C, based on randomised trials and systematic reviews.
The European tinnitus guideline (Cima 2019, referenced in Sereda et al., 2022) also recommends against ginkgo. The AWMF S3 guideline for Germany uses the strongest possible recommendation language against it.
No major clinical guideline recommends ginkgo for tinnitus in any form.
What to Try Instead
A negative answer is frustrating, especially when you have been hoping this might be the one that works. The honest response to that frustration is not to recommend a different supplement. It is to point toward what the evidence does support.
Cognitive behavioural therapy (CBT) for tinnitus has the strongest evidence base of any psychological intervention. It does not silence the sound, but it significantly reduces the distress and functional impact tinnitus causes. The AAO-HNS guideline recommends it. For people with hearing loss alongside tinnitus, hearing aids and sound therapy reduce the contrast between the tinnitus and the external acoustic environment, which reduces how prominent the sound feels. Tinnitus retraining therapy (TRT) combines sound therapy with educational counselling and has good supporting evidence for reducing tinnitus intrusiveness over time.
These approaches do not promise silence, but they are backed by clinical trial evidence and endorsed by the guidelines that reviewed the same literature discussed in this article.
Conclusion: The Honest Verdict on Ginkgo and Tinnitus
Ginkgo biloba is the most studied herbal supplement for tinnitus. That is genuinely true, and the research effort was worth conducting. The result of that research, pooled across 12 rigorous trials with 1,915 participants, is that it does not work for primary tinnitus (Sereda et al., 2022). It also carries real safety considerations for the many tinnitus patients who are on blood-thinning medications.
A negative finding is not the answer anyone wanted. But knowing which options lack evidence is genuinely useful: it frees you to focus on the approaches that have real support. CBT, sound therapy, and hearing rehabilitation are not as easy to find on a pharmacy shelf, but they are where the clinical evidence actually points.
