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Ginkgo biloba tinnitus study, how to cure ringing in ears after a concert - Reviews

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In the framework of a systematic literature survey, 19 clinical trials investigating the effects of tinnitus treatment with Ginkgo biloba special extract EGb 761 were identified and evaluated.
The varying forms of tinnitus do not only differ with respect to their sound and frequency but also as concerns loudness and periodicity. The highly purified and concentrated monoextract EGb 761 obtained from the dried leaves of the Ginkgo biloba tree is a special extract manufactured according to a patented standardized pharmaceutical process. All clinical trials documented in the scientific literature on the efficacy and tolerability of Ginkgo special extract EGb 761 in patients with subjective tinnitus were to be included in this survey.
After inspection of the published studies, 19 trials were selected on the base of the above-mentioned criteria, eight of which having been carried out under controlled conditions and eleven without reference groups. Efficacy of Ginkgo special extract EGb 761 as compared with placebo or reference substances. Table 1: Controlled clinical trials with Ginkgo special extract EGb 761 as against placebo or reference substances in patients suffering from tinnitus. Early controlled studies compared the effect of EGb 761 with other active substances used for the treatment of disorders of the inner ear. Patients with cerebrovascular insufficiency or disorders of the inner ear of different origin also suffering partly from ear noises were investigated in three placebo-controlled clinical trials: In the study by Eckmann and Schlag 1982 [7] twelve patients treated with EGb 761 and 20 placebo patients suffered from tinnitus in the context of a cerebrovascular insufficiency. Table 2: Survey on clinical trials without reference group conducted with Ginkgo special extract EGb 761 in patients suffering from tinnitus.
The 1802 tinnitus patients involved suffered from ear noises in the context of cerebra-vascular circulation disorders or from disorders of the inner ear of different origin with symptom complexes including ear noises relatively frequently. In all clinical trials, safety and tolerability of the medication with Ginkgo special extract were very good and good.
The results of this systematic literature survey show that the effect of Ginkgo special extract EGb 761 in tinnitus patients was investigated in numerous studies partly involving large patient numbers. As based on the present results from clinical studies, it can be stated as summary that Ginkgo special extract EGb 761 is an effective and very well tolerated medication which can be applied for the treatment of ear noises of varying origin and duration.
The results of a systematic survey on the treatment of tinnitus patients with EGb 761 in the framework of clinical studies show the efficacy and good tolerability of Ginkgo special extract as compared to placebo or reference substances. Many people assume when buying herbal supplements for the treatment of tinnitus (such as Ginkgo biloba) that most products are pretty much alike. Consumer Labs has tested many nationally recognized brands of Ginkgo biloba and found that less than 23% contained all necessary components to be considered a cliniically effective ginkgo. There are indeed several high quality ginkgo products sold in the better health food stores. The leaves are extracted using grain ethyl alcohol and water and then processed a second time to remove ginkgolic acids. Like all Ginkgo products, Ginkgoforce® may cause side effects, although not everybody gets them. The results of eight controlled studies on tinnitus due to cerebrovascular insufficiency or labyrinthine disorders of varying origin showed for the most part a statistically significant superiority of the treatment with Ginkgo biloba special extract EGb 761 as compared with placebo or reference drugs applied for periods of one to three months. As compared to tinnitus which is only perceived subjectively, ear noises in case of objective tinnitus are assessable diagnostically, i.e. Restriction to studies with Ginkgo special extract EGb 761 is due to the problematic comparability of plant extracts from different manufacturers [16]. Subjective tinnitus symptoms were recorded in these studies according to an operational procedure defined in the trial plan. These are for the one part smaller studies with pilot character but also important investigations on efficacy and tolerability in the daily practice.
With different treatment periods between 40 days and six months, more or less pronounced improvements of the tinnitus symptoms or elimination of the ear noises were obtained in most studies.
In as far as mild disorders or treatment discontinuations occurred due to side-effects, no pronounced differences between the EGb 761-treated groups and the respective reference groups were found in the controlled clinical studies.
The superior efficacy of EGb 761 as compared to reference groups could be verified statistically in the five placebo-controlled studies. The efficacy could be demonstrated in tinnitus of different origin and duration, but prognosis is generally better in case of short duration of the disease so that treatment should be started as early as possible.

They will not allow any ginkgo product to be sold in Germany that has over 5 parts per million (PPM) of ginkgolic acid.Arches Tinnitus Formula contains less than 1 PPM of ginkgolic acid, the lowest found on the world market.
Our Ginkgo leaves are collected from cultivated trees, grown in 2 to 3 metre high hedges.1 tablet contains 90 mg of extract (as dry extract) from Ginkgo biloba L. Open studies, too, some involving large numbers of patients, revealed appreciable improvements under Ginkgo treatment, Therapeutic success was not directly correlated with either the genesis or the duration of tinnitus. A further blood-flow promoting measure in acute tinnitus and in long-term treatment is the administration of Ginkgo special extract EGb 761.
Data bases of EMBASE (unlimited until January 1998) and MEDLINE (unlimited until July 2000) were used for the identification of the studies. 1979 [23] versus the vasodilator Cinnarizin, mild to marked improvements of ear noises were reported in 11 out of 13 patients treated with Ginkgo special extract as against mild improvements in two out of 13 patients in the Cinnarizin treatment phase. Patients for whom surgical, antibiotic or other medical treatments were indicated, were excluded from the study. The tinnitus whose sound type could be defined and which could be masked persisted for at least two months.
Table 2 gives a survey of the studies with the major data on the patients examined and the methods applied as well as on the results on efficacy in tinnitus treatment. In one of these studies, the audiometrically measured decrease in tinnitus volume was within a range of 5 to 10 dB which is to be considered as clinically relevant [20]. In fact, it is often not possible on the one hand to find a tinnitus origin that can be treated causally, but on the other hand, the ear noises are subjectively very stressing for the patient. While Ginkgo biloba is available in any health food store and many discount stores, individuals with tinnitus should exercise care when selecting a product.
Many of the inferior, low priced brands can contain as much as 100 – 1000 PPM of ginkgolic acid.
Arches ginkgo is extracted with ethyl alcohol and water and then treated to remove impurities. Ginkgoforce® Ginkgo is a traditional herbal medicinal product used to relieve the symptoms of Raynaud's Syndrome and Tinnitus.2. Independent of its intensity, tinnitus is so oppressing in l-2% of the patients that it leads to a decrease in working capacity and even to inability to work and suicide tendency (decompensated tinnitus).
Tinnitus is often induced by exceptional situations of life such as loss of one’s spouse or a close reference person, job or financial problems [22] which explains the importance of a good psychological assistance during therapy of a tinnitus patient. This large action spectrum leads to its application in different fields of indication such as vertigo and tinnitus, peripheral arterial occlusive disease and dementia1 syndromes. Results obtained with the search terms “ginkgo” and “tinnitus” showed that nearly all studies found were carried out with the Ginkgo special extract EGb 761. In addition, tone-audiometric measurements on tinnitus volume and other criteria were applied in some studies which, however, were used for assessing therapeutic success in only one case. In a comparative study with the vasodilating substance Nicergolin [3], clear improvements without group differences were observed in 15 patients with ear noises of the Ginkgo special extract group and in 14 patients of the Nicergolin group as against the initial state. Statistically remarkable differences in efficacy as compared to placebo and in favor of a treatment with Ginkgo biloba were also seen in a study by Mangabeira Albernaz et al. After a twelve-week randomly allotted therapy with EGb 7618 or placebo, statistically significant group differences in favor of the patients treated with Ginkgo special extract were found. Tinnitus intensity was measured audiometrically and by means of subjective assessment (rating scale). The three reference-controlled studies showed that the effects of Ginkgo special extract EGb 7618 can be rated as comparable [3] to significantly better [19, 23] as against the vasodilators nicergolin, almitrin-raubasin and cinnarizin.
For the majority of the cases, the most probable cause was a cerebrovascular insufficiency, but the studies also investigated a large number of patients with disorders of the inner ear of different or not clarified origin and with variable symptoms. Due to the lack of regulation of the herbal and vitamin industry within the United States, most ginkgo products are of inferior quality. The tolerability of Ginkgo biloba special extract EGb 761 was very good and, in this respect, the controlled clinical trials revealed little difference between active-substance groups and reference groups.
Depending on the duration of tinnitus, it is also classified in acute and chronic forms with chronic tinnitus meaning symptoms persisting for at least three months [15].

Clarification of possible somatic causes is primordial for trying to find an efficient way to help the tinnitus patient. The efficacy of the special extract EGb 761 is demonstrated for the above-mentioned indications by pharmacological and clinical studies [27].
Upon request, the manufacturer of this extract made available further published studies which were not recorded in the data bases mentioned. Tinnitus intensity decreased more markedly between the first and last date of examination under treatment with the active-substance than under placebo (p=0.03). In addition, prognostic factors such as duration of disorder (longer or shorter than 30 days), localization (unilateral, bilateral) and periodicity (permanent, intermittent) were investigated in this study. In those cases in which laboratory parameters were measured during the study, no medication-related changes were observed. The results did not indicate a relation between the efficacy of Ginkgo special extract EGb 761 and the tinnitus genesis.
The present systematic literature review thus also contributes to the conception of evidence based medicine in the treatment of tinnitus.
Perhaps most importantly, it contains a minimum of 3.6% bilobalide which, as discussed above, is responsible for protection of the neuronal circuits in the inner ear.
Removing the ginkgolic acid requires a separate manufacturing process that is very expensive… but worth it! The objective of the present systematic investigation is to give a survey on the efficacy and tolerability of Ginkgo special extract EGb 761 in the treatment of tinnitus aurium as based on the results of all clinical studies carried out with this extract in tinnitus patients. From these identified clinical studies were taken into consideration all investigations in which Ginkgo special extract was administered orally for at least two weeks at a daily dose between 120 and 240 mg.
In the framework of the literature search three other studies were selected which did not comply with the treatment criteria fixed since EGb 761 was either administered intravenously over merely eight days [25] or the therapeutic phase was preceded by a 10-day intravenous treatment with the Ginkgo special extract [21] or the oral daily dose was markedly below the search criteria with 2 x 14.6 mg [12]. The improvements under Ginkgo special extract EGb 761 were situated within a range of 5 to 10 dB.
In nearly all uncontrolled studies too, clinical improvements of tinnitus symptoms were found in partly very large numbers of patients. The investigations showed a clinical efficacy of EGb 761 in case of acute and chronic tinnitus auris.
The authors of a recently published survey on the treatment of tinnitus patients with Ginkgo extracts [8] in which, however, merely four controlled clinical studies with the Ginkgo special extract EGb 761 [12, 18-20] and one study with a Ginkgo extract of another manufacturer were evaluated, also come to the conclusion that the results are indicative for a therapeutic benefit of Ginkgo extracts in tinnitus treatment. This causes the important terpene lactones (essential to tinnitus relief) to be immediately crushed and oxidized – losing all of their potential benefits.
We also included those studies in which tinnitus patients represented a sub-group of a patient population suffering from other inner ear disorders or disturbances of cerebral performance of vascular origin.
As concerns the symptom tinnitus, an improvement was observed in five (31.3%) of the verum patients but in none of the placebo patients. It could be shown that Ginkgo special extract EGb 7618 lead to better therapeutic results in all prognostic groups and that globally, the factors “first occurrence”, “unilateral” and “intermittent” had a better prognostic value. Since ear noises frequently persisted for a longer time already and the spontaneous healing rate could thus be expected to be rather low, the results of the uncontrolled clinical studies are also important for the proof of efficacy. Two large-scale studies, however, established that in case of shorter durations of the disease a better prognosis and treatment success are to be expected in general [18, 24].
For the selection of the studies, no restrictions were applied with respect to the study design, i.e. In another study involving patients with mild to moderate cerebrovascular insufficiency too [11], a statistically significant decrease in ear noises could be demonstrated under EGb 761 whereas this symptom remained nearly unchanged under placebo (p = 0.035). Tolerability of the Ginkgo special extract EGb 761 was very good to good in all investigations. Other diseases of the peripheral auditory system too, such as Meniere’s disease, sudden hearing loss, blast trauma or acute otitis media, may appear in combination with tinnitus.

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