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Tinnitus research group, herbs for ringing in the ears - Try Out

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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. 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. Table 1: Controlled clinical trials with Ginkgo special extract EGb 761 as against placebo or reference substances in patients suffering from tinnitus.
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. Besides the controlled clinical trials listed, a great number of clinical trials without reference group were carried, too. 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. 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.
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.
University of Regensburg, Department of Psychiatry and Psychotherapy, and Tinnitus Research Initiative, Regensburg, Germany.
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. Subjective tinnitus symptoms were recorded in these studies according to an operational procedure defined in the trial plan. After a 30-day treatment, the ear noises were eliminated in all patients of the active-substance group whereas this symptom was still present in ten patients of the placebo group. 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.
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. 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. 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. 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.
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. Improvement or elimination of ear noises was achieved in 50% of the cases in the active-substance group as a mean after 70 days and in the placebo group only after 119 days (p=0.03). Tinnitus intensity was measured audiometrically and by means of subjective assessment (rating scale). 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.
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). 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. 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. Based on these factors, the patients were retrospectively distributed in five prognostic groups and analyzed with respect to the therapeutic success. 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.
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. As compared to these values, the values obtained in the placebo group remained nearly unchanged. An essential difference between EGb 761 groups and the respective reference groups could not be shown. 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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