Is There a Treatment for Tinnitus

There are several features of a symptom or illness that make it a convenient target for proponents of unconventional therapies. Subjective symptoms are more likely to be targeted than objective conditions – you don’t see many so-called “alternative” birth control treatments. Symptoms for which placebo effects alone are likely to produce the illusion of effectiveness are good targets for ineffective treatments. Symptoms that vary naturally over time also are good targets – patients are likely to seek treatment when their symptoms are maximal, which means spontaneous regression to the mean will provide an effective illusion of efficacy for any intervention.  Illnesses with a substantial psychological component (such as those that are worsened by emotional stress or that are emotional, such as anxiety) are likely to benefit from non-specific effects of the therapeutic interaction, rendering the treatment itself irrelevant.

Finally, any condition or symptom for which there is currently no effective treatment provides a market ripe for exploitation.

Tinnitus has many of these features. Tinnitus describes the subjective experience of spontaneous noise perceived in one or both ears, which can be a buzzing, hiss, tone, or ringing sound. The severity of the tinnitus, its loudness, can vary over time, but perhaps more importantly the degree to which the tinnitus is bothersome can vary considerably. The sound is distracting and can have a significant impact on quality of life. Those with tinnitus can ignore the sound at times (depending on its severity), can be distracted from the sound, and may even learn through cognitive therapy to become accustomed to it. Therefore we might expect that tinnitus is amenable to placebo effects.

Finally, there is no proven effective treatment for tinnitus, which means that those who suffer from tinnitus may be desperate for a treatment. Desperation is a commodity highly prized by snake-oil salesmen.

Not surprisingly, there are a few “alternative” treatments that claim to be effective for tinnitus. There are also some experimental but scientifically legitimate treatments. Neuroscientists are still uncertain about the cause – the pathophysiology – of tinnitus. One theory, however, is that it is caused by insufficient tonic inhibition (the nervous system generally functions by inhibiting the firing of neurons at baseline, until they are activated). GABA is the most common inhibitory neurotransmitter in the brain, so it is possible that decreased GABA activity in the auditory system is one component of tinnitus. Drugs that increase GABA activity in the brain, therefore, would be a plausible treatment for tinnitus.

One GABA agonist drug, vigabatrin, has been tested on an animal model of tinnitus and has shown some effectiveness. We do not yet know, however, how predictive or useful the animal model is, and the drug has not been tested in humans. This is, therefore, extremely preliminary information and not an adequate basis for treatment decisions. Another GABA drug, gabapentin, has been tested in humans. A recent review found only two studies worth considering, both of which concluded that gabapentin was no more effective than placebo. The studies were insufficient, however, to definitively rule out an effect.

There is also preliminary evidence that the drug clonazepam may be effective for tinnitus. This drug, however, also has anti-anxiety effects and the study was open-label, so it is too soon to make any definitive conclusions.

That’s about it for science-based pharmacological therapy for tinnitus. There are other treatments, such as tinnitus retraining therapy (TRT) and tinnitus masking (TM). There is one study showing efficacy of TRT compared to TM (not blinded and not placebo-controlled), with significant effects for severe tinnitus and modest effects for mild to moderate tinnitus. TM involves using earphones (essentially hearing aids) that produce a masking noise meant to cancel out the tinnitus. At present these two interventions appear to be the most effective treatments for tinnitus, but their effectiveness is modest.

I have found three “alternative” treatments recommended for tinnitus. The most common is the herb Ginkgo biloba. Ginkgo is more commonly recommended for dementia or memory difficulty, although the best evidence to date shows that it is completely ineffective for this condition. Ginkgo is also offered as a treatment for tinnitus, with the same hand-waving justification as for memory symptoms. Dr. Weil recommends it for tinnitus and claims:

Ginkgo may help by increasing blood circulation in the head and neck. Give it at least a two months trial.

The evidence, however, is not with Weil – the best study to date shows no effect from Ginkgo:

There were no significant differences in primary or secondary outcome measures between the groups. 34 of 360 participants receiving active treatment reported that their tinnitus was less troublesome after 12 weeks of treatment compared with 35 of 360 participants who took placebo.


50 mg Ginkgo biloba extract LI 1370 given 3 times daily for 12 weeks is no more effective than placebo in treating tinnitus.

A Cochrane systematic review concurs that Gingko is ineffective.

Dr. Weil also recommends craniosacral therapy (CST) from a naturopath for tinnitus. This is a completely unscientific therapy. Mark Crislip does an excellent job of explaining why CST is nonsensical and unscientific – it has something to do with the fact that the bones of the skull are fused and cannot be manipulated in the manner claimed by CST. Just to be thorough, I did  a PubMed search for craniosacral therapy and tinnitus and came up with zero results. A recent systematic review of CST for any condition concluded:

This review revealed the paucity of CST research in patients with different clinical pathologies. CST assessment is feasible in RCTs and has the potential of providing valuable outcomes to further support clinical decision making. However, due to the current moderate methodological quality of the included studies, further research is needed.

In other words, there is no evidence that CST works for anything. The ubiquitous conclusion that “further research is needed” is an excellent example of the difference between evidence-based medicine and science-based medicine. The SBM conclusion would be quite different – Considering the extreme scientific implausibility of CST, not one penny or scientific resource should be expended further studying this fanciful notion.

There is also a homeopathic treatment for tinnitus that has been widely marketed recently. The product is known as Quietus (not to be confused with the suicide drug from the excellent movie, Children of Men). The Quietus website proclaims:

Quietus® homeopathic tablets are formulated to homeopathically help support the body’s own healing mechanism that cancels out symptoms such as roaring, buzzing & whizzing, and supports healthy functioning in the inner ear… safely & naturally.

The site does not list the homeopathic “ingredients” of this product. It doesn’t matter, of course, because most homeopathic preparations are diluted to the point that there are no active ingredients left. I say “most” because some products may be only slightly diluted and still contain active ingredients, which is worse because then direct toxicity becomes a possibility.

There is no evidence that Quietus or any homeopathic preparation is effective for tinnitus (or for any indication, for that matter). The marketers of Quietus offer only testimonials, which are worse than useless given that they are cherry picked to give a certain impression. The website does contain the usual CAM disclaimer:

 **These results not typical. Individual results will vary. These real testimonials do not represent the typical or ordinary experience of users. Each person’s experience with Quietus® is different, which cannot be determined from these testimonials. These statements have not been evaluated by the Food and Drug Administration. Claims are based on traditional homeopathic principles, which are different than modern scientific testing. For more information on homeopathy, please visit

If any visitor bothers to follow the link to the NCCAM website they will find this statement about homeopathy:

There is little evidence to support homeopathy as an effective treatment for any specific condition.

Several key concepts of homeopathy are inconsistent with fundamental concepts of chemistry and physics.


Tinnitus is a difficult symptom at present with no clearly effective treatment. Scientific research is increasing our understanding of the cause(s) of tinnitus and there are some plausible treatments being researched.

So called “alternative” therapies, however, have nothing to offer. Herbs are simply drugs that are not purified and are difficult to standardize. If an herb contains an active ingredient that might be effective in treating tinnitus (or any condition) it should be identified, purified, and studied. In any case, the herb Ginkgo which is claimed to be effective for tinnitus is ineffective according to the best available evidence.

Craniosacral therapy and homeopathy are both rank pseudosciences that have no plausibility as treatments and for which there is no evidence of efficacy for anything, including tinnitus.

For now we have to accept the fact that there are no proven therapies that are highly effective for tinnitus. The best chance for developing solutions comes from science-based assessments of plausible treatments, and from not wasting time and resources on fanciful nonsense.


Posted in: Neuroscience/Mental Health

Leave a Comment (69) ↓

69 thoughts on “Is There a Treatment for Tinnitus

  1. windriven says:

    Dr. Novella’s “Great Courses” series is offered on the inside back cover of this week’s The Economist at a reduced price for any who might be interested.

  2. windriven says:

    “A Cochrane systematic review concurs that Gingko is ineffective.”

    Wow! A Cochrane review that doesn’t recommend further study. Talk about the kiss of death.

    In the famous windriven study (N=1), it was demonstrated that an engaged mind is less troubled by moderate tinnitus than the unengaged. Reading, listening to music, listening to podcasts and so forth focus attention away from the ringing and leave the mind engaged even when the primary stimulus has ended. Navel gazing and pondering the physics of homeopathy do not show similar effects. While not a cure it is an effective palliative. Cochrane has yet to weigh in on the windriven study, likely because of its high quality and indisputable conclusion.

  3. kirkmc says:

    I have central tinnitus, and gabapentin did nothing for me. However, small doses of clonazepam seem to reduce the intensity a bit. Both my neurologist and ENT recommended it, and when I get periods when it’s really annoying, I take some at bedtime.

  4. DugganSC says:

    Purely anecdotal of course, but I’ve found that my only method of preventing tinnitus is to avoid diet drinks. For some reason, they tend to trigger it. I don’t know if it’s the artificial sweetener or some other chemical in it, but like someone with a food allergy, I just avoid it.

  5. elburto says:

    The windriven study matches up with the results of the elburto study, which had double the number of participants.

    Despite the RNID* recommending special (and expensive) white noise machines as a sleep aid, the elburto study found that a £10 MP3 player with a white noise track on it was equally effective. It also had the bonus result of inhibiting possible insomnia based on the “This device had better work, it cost four days wages” effect.

    I would love a cure for tinnitus, but until we know why it actually happens, the only way a possible cure might emerge is by accident.

    Pulsatile tinnitus is the worst for me, I’ll take the sine wave variant any time. Just. as well really, as reading this post has “reminded” me that I have it, and unfiltered the noise.

  6. elburto says:


    “RNID = Royal National Institute for the Deaf.

  7. Narad says:

    The site does not list the homeopathic “ingredients” of this product.

    It comes in different formulations, but this jibes with the article they ginned up for The Hearing Journal:

    Tablets: China Officinalis 6X (Cinchona Bark); Chininum Sulphuricum 4X (Sulphate of Quinine); Kali Iodatum 3X (Iodide of Potassium); Kali Phosphoricum 3X (Phosphate of Potassium); Natrum Salicylicum 6X (Salicylate of Sodium); Salicylic Acid 6X (Salicylic Acid). Ear Drops: Belladonna 6C; Apis Mellifica 6C; Aristolochia Clematis 6C; Chamomilla 6C; Lachesis Mutus 6C; Thuja Occidentalis 6C

    So, not trans-Avogadro, although the relative quantities aren’t specified.

  8. MTDoc says:


    Thanks for the tip. I’m a fan of “great courses”, but missed this one. Now I get to see him in action. Didn’t realize he works at my alma mater. Incidentally where I come from, quietus does not rhyme with tinnitus.

  9. Harriet Hall says:

    I have tinnitus, presumably from occupational noise exposure in the Air Force, qualifying for 10% disability from the VA. I hadn’t thought about it in a while, but as soon as I started to read this article I became acutely aware of it.

    I have a theory (a hypothesis, actually). It may be entirely misguided, but I want to share it to see what others think. When I first noticed my tinnitus, I was not alarmed. I interpreted it as a harmless effect of noise exposure and nothing but a minor nuisance. I tried to ignore it and I succeeded. When I think about it, it is always there; but I seldom think about it.

    What if I had been alarmed by the initial symptoms? What if I had been worried that it was the sign of some serious underlying condition? What if I had been afraid I would go deaf? What if I had fixated on the sound and paid constant attention to it? Might I have trained myself to a higher level of sensitivity?

    Since tinnitus is subjective, I can’t compare my experience to others. Some people may have far louder, more disruptive tinnitus that unavoidably interferes with their life. But I suspect that at least some people with tinnitus would have suffered less if they had given the initial symptoms a less alarming interpretation. Neurophysiology tells us that repeated use of a nerve pathway reinforces that pathway and can even change the brain’s anatomy. I’m guessing that at least some patients are suffering because of learned behavior, and that very early reassurance and distraction might have prevented some of these cases from developing into a significant problem. I’m guessing that the methods of tinnitus retraining might be even more effective for prevention than for treatment.

    Thoughts, anyone?

  10. Harriet Hall says:


    “I’m a fan of “great courses”, but missed this one”

    You wouldn’t have missed it if you had been reading SBM:

  11. David Gorski says:

    As a side note, I thought that one of the better portrayals of tinnitus was just on TV in last week’s episode of Boardwalk Empire. The main character, Nucky Thompson, had just survived an attempt on his life in which his enemy had set off a bomb at a restaurant he and his “business” associate were going to dine at. They were delayed, and the bomb went off before they actually entered the restaurant, but Nucky was close enough to the blast radius that he suffered a closed head injury (concussion). The way his tinnitus was portrayed, with people’s voices fading into the distance was actually pretty well done. Come to think of it, so was the portrayal of his symptoms of the concussion, in which he kept forgetting things, particularly things he had just said or done, and was prone to emotional swings not characteristic of his personality.

  12. evilrobotxoxo says:

    As always great article. I have only one nitpick: I don’t think Gabapentin is believed to work on the GABAergic system any more. They used to think that, hence the name, but now I think the main mechanism is believed to have something to do with calcium channel accessory subunits.

    Also, I don’t know how this stuff will pan out, but there is some exciting work on tinnitus from a group in Texas where they pair auditory stimulation with vagal nerve stimulation to induce synaptic plasticity that inhibits the abnormal activity associated with tinnitus. There is a company called MicroTransponder that has an implantable device built on this principle that has apparently gotten positive results in a phase I trial. Not ready for prime time yet, but it sounds promising, and unlike current treatments it’s based on a pretty sophisticated understanding of the underlying pathophysiology of tinnitus.

  13. MTDoc says:


    Now that I think about it I have tinnitus too! Along with high frequency hearing loss that I also attribute to my flight surgeon days. Remember how quiet your car engine sounded after a long flight ? I can successfully ignore the ringing by doing things, but of course can not equate my situation with others who might have different etiologies or pathology. Just ordered the above mentioned course, and by the way I enjoyed your book; brought back lots of memories of military culture, albeit my service was a decade earlier.

  14. cedge20 says:

    Dr Hall, your comment re tinnitus and learned behavior reminded of two things. One, I vaguely recall some study (or two) about chronic pain patients — something about how the focus on pain increased the awareness/existence of pain? Also, I have bouts of vertigo; my GP has told me there are some studies about retraining the brain; the idea with vertigo is to consciously create a vertiginous situation and let the brain work on it. So far I haven’t tried this as I have no interest in, say, going on a rollercoaster…

  15. kirkmc says:


    It’s called balance therapy, and it’s nothing like a roller coaster. A number of methods are used to force the balance system to work harder. It’s nothing new either.

  16. Alia says:

    My mother is suffering from mild tinnitus. She went to a doctor and he prescribed gingko (I’m not sure if he was a quack or knew that the stuff does not work but hoped for placebo effect). Anyway, my mother may be rather elderly, but she’s also very inquisitive, so the first thing she did when she came home was checking the stuff on the internet. When she found out it’s a supplement with no proven clinical effect, she did not buy it (ditto for lutein prescribed by an ophtalmologist). She claims that listening to classical music quietly helps a lot – but I might encourage her to try with white noise.

  17. Robb says:

    Alia, your doctor may have prescribed Ginkgo biloba for your mother due to reading Reviews like this one:
    This review is from 2011 whereas the Cochrane one linked in the original post is from 2004. The review I linked covers studies all on one specific Ginkgo extract whereas the Cochrane one covers many different types (definitely a shortcoming/challenge when it comes to herbal research). I haven’t read or analyzed either review in great detail yet but wanted to include it for completeness since it doesn’t make much sense to try and cover the topic by cherry picking a single review that suits your conclusion. They do cover the topic of past reviews that found no benefit. Also, this is a minor nitpick/pet peeve but no one throughout the entire post and comments even spelled the name of the herb correctly.

  18. Jeff says:

    The LEF website has an article on tinnitus. It includes a description of various nutritional therapies:

  19. Lost Marble says:

    @ HH
    I notice my tinnitus when I have a panic attack,
    I’ve always associated it as coming from panic, not panicking when I notice it. A bit of a twist on your theory, or just poor observation on my part.

  20. ConspicuousCarl says:

    I get it too. It seems to happen more when I am sick or lacking sleep. That seems to be suggestive, but in those cases I am usually alone, doing nothing, and avoiding noise sources, which are also consistent with non-symptom periods being the result of having other things to hear and think about.

    It sounds a lot like the hiss old tube TVs would make when turned on but not playing any sound. That has limited value as a description because most people said they could barely hear the TV hiss, if at all.

    And by the way, f#&% Andrew Weil for adding to the white noise. I don’t have a severe enough form of this to be “suffering” from it, but some people do. It’s bad enough to have a condition with no solution, but you can’t even get that answer without wasting time sifting through endless piles of bull$*%t thrown at you by fraudulent jerks who don’t mind flooding the Internet with lies to justify their existence and sell bottles of junk.

  21. Bryan Bartens says:


    A couple of family members already had tinnitus years before I did, and they never seemed to worry about in terms of underlying diseases or anything. So when it was my turn to start hearing noises, at a much younger age, I didn’t think much of it. One of them told me the only thing that worked for her was imagining a plausible source for the noise she was hearing. The sound I’m hearing is a bit like that of water running through heating pipes. So whenever I become aware of it I reassure myself that’s what I’m hearing. Always does the trick, even on a hot summer day :)

  22. BillyJoe says:

    I’ve had tinnitus for as long as I remember…in the form of a soft humming sound that is only audible when everything else is quiet.

    In my childhood, I thought that it was the sound of the universe idling along.
    In my slightly more sophisticated adolescence, I thought that it was the cosmic background radiation.
    But now I realise that it is all in my head.


  23. BillyJoe says:

    …that was a true story by the way.

  24. Shelley says:


    You’ve described exactly the kind of thought processes I see as a cognitive behavioral therapist, and this likely explains some of the success in any CBT treatment for tinnitus. For people with panic attacks, health anxiety, chronic pain and so on, there is a tendency to ‘catastrophize’ benign medical symptoms and provoke a sympathetic nervous system reaction. Of course when this happens, there is an increase in the the severity of any existing symptom (through attentional focus and vigilance) and it provokes additional physical symptoms associated with activation of the “fight-flight” system.

    Though I’ve never treated tinnitus, my guess would be that CBT would treat it through information/de-catastrophizing, self-talk that directly addresses worried thoughts, and behavioral changes such as increased activity (busy people generally become absorbed in other activities and tend to notice it less), and a simple mp-3 player at night.

    As an aside, on occasion I’ve recommended audiobooks, podcasts etc on an mp3 player for patients in bed at night when they just can’t get past bed-time anxious rumination.

  25. @kirkmc..((I have central tinnitus, and gabapentin did nothing for me. However, small doses of clonazepam seem to reduce the intensity a bit. Both my neurologist and ENT recommended it, and when I get periods when it’s really annoying, I take some at bedtime.)) said “when I get periods it’s really annoying”…I’m wondering if it isn’t iron deficiency that may cause your (tinnitus).

    I know you didn’t ask my opinion, but I just thought I’d mention it. Why, because I read someone took molasses as an iron source for energy as she was going through chemo and radiation treatment..and she experienced a tremendous amount of energy..however, she also had tinnitus, and within a week or so, her tinnitus also diminished to almost nothing. Just an idea :)

  26. DugganSC says:

    Huh. I’d never even thought of the differences in sound. For me, it’s like holding a seashell up to my ear. More distracting than masking. Although, given that it seems to have a particular trigger of the diet drinks and the general sound, now I’m wondering if maybe it’s got something to do with rushing blood and/or errors in that bit of they body that keeps us from being deafened by the sound of our chewing (something I’ve also had mild issues with over the years. I can’t eat anything crunchy while watching TV because I can’t hear a word they’re saying).

  27. Actually, I just ‘googled’ and..this is an article..

    If someone has a severe enough iron deficiency, they can easily develop tinnitus. The severity of the tinnitus depends on how serious the mineral deficiency is, varying depending on the individual. An iron deficiency is a common explanation for anemia which in turn can cause tinnitus. This particular condition is referred to as sideropenic anemia.

  28. Robb – I saw that review but did not include it because I thought it was very poorly done. Almost all the studies included were very preliminary with small numbers of subjects and inconsistent results. The two studies that had significant numbers were primarily studies of dementia and cerebrovascular insufficiency. Both are published in obscure German journals. The first makes no mention of tinnitus in the abstract and I cannot get the whole article, and the other one I cannot even find the abstract.

    The bottom line is that there is no particular reason to think that this one Ginkgo formula should work while others do not, and there are no good studies of it with tinnitus in any case. So still, the best studies of Gingko so far with tinnitus are negative.

    The review I included was the most recent thorough review that followed some standard. The 2011 one is single author and of such low quality I did not think it worthy of inclusion. But is shows how a crappy study (or review) can have an inappropriate disproportionate effect, if indeed anyone is basing a clinical decision on that review.

  29. Grant Ritchey says:

    In dentistry, there are a lot of claims that jaw position and the occlusion (the way the teeth fit together) might have a correlation with tinnitus in some situations.


    But as we all know, correlation does not mean causation, and the relationship is equivocal and study under study:

    There is biological and anatomical plausibility, as the posterior wall of the TMJ is adjacent to and coincident with the anterior wall of the ear canal. (See diagram: Conceivably, inflammation in the TMJ could cause a fullness in the ear (patients report feeling like they have water in the ear or just pressure) or even full blown tinnitus (ringing and buzzing in the ears). I have personally seen cases of tinnitus that resolved when the underlying jaw problem is corrected, and I have seen cases that didn’t improve at all. Maybe the cases that improved would have without treatment. So, the jury is still out, and in my office, I don’t ever claim that what I do TMJ wise will treat their tinnitus, but when it does (either by my intervention or by luck), it’s a pleasant surprise.

    Grant Ritchey

  30. Grant Ritchey says:

    In dentistry, there are a lot of claims that jaw position and the occlusion (the way the teeth fit together) might have a correlation with tinnitus in some situations.


    But as we all know, correlation does not mean causation, and the relationship is equivocal, according to other studies.

    There is biological and anatomical plausibility, as the posterior wall of the TMJ is adjacent to and coincident with the anterior wall of the ear canal. (See diagram: Conceivably, inflammation in the TMJ could cause a fullness in the ear (patients report feeling like they have water in the ear or just pressure) or even full blown tinnitus (ringing and buzzing in the ears). I have personally seen cases of tinnitus that resolved when the underlying jaw problem is corrected, and I have seen cases that didn’t improve at all. Maybe the cases that improved would have without treatment. So, the jury is still out, and in my office, I don’t ever claim that what I do TMJ wise will treat their tinnitus, but when it does (either by my intervention or by luck), it’s a pleasant surprise.

    Grant Ritchey

  31. Grant Ritchey says:

    In dentistry, there are a lot of claims that jaw position and the occlusion (the way the teeth fit together) might have a correlation with tinnitus in some situations.


    But as we all know, correlation does not mean causation, and the relationship is equivocal, according to other studies.

    There is biological and anatomical plausibility, as the posterior wall of the TMJ is adjacent to and coincident with the anterior wall of the ear canal. (See diagram: Conceivably, inflammation in the TMJ could cause a fullness in the ear (patients report feeling like they have water in the ear or just pressure) or even full blown tinnitus (ringing and buzzing in the ears). I have personally seen cases of tinnitus that resolved when the underlying jaw problem is corrected, and I have seen cases that didn’t improve at all. Maybe the cases that improved would have without treatment, I don’t know. So, the jury is still out, and in my office, I don’t ever claim that what I do TMJ wise will treat their tinnitus, but when it does (either by my intervention or by luck), it’s a pleasant surprise and I look like a hero.

    Grant Ritchey

  32. Grant Ritchey says:


    (Sorry for the repeat posts. I must have gone crazy with the Submit button. Feel free to delete the first two)

  33. elburto says:

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    Yeah, so this is where elburto gets nasty (her name forms an apt anagram) about a company that offers ‘Lifetime Membership’ with access to a shop full of “Lifesaving therapies” for *only* $1500.

    OK. I despise charlatanry like this. I had the most amazing Nanna. She was my maternal grandmother, and was only 41 when I was born, so not the usual image of a white-haired old dear in a twinset and pearls. She doted on me, the “First and best” grandchild, an was a big influence on me.

    She was dead by 69. Dead from avoidable heart failure. Dead because lying scam artists with a veneer of respectability (I’m looking at you, Holland and Barrett) and mail order companies were offering a “safer way” to treat illness, than “chemicals” like those in her anti-hypertensives, and other prescribed drugs.

    She wanted more time to spend with her beloved husband, her grandchildren, and her new great-grandchild. Promised relief and healing without side-effects, she spent thousands on jars and bottles of pills, powders, and liquids.

    She was incredibly intelligent, but believed everyone was essentially honest and good. We used to joke that she was more likely to be found murdered, than to die from old age, thanks to her habit of bringing homeless people home with her.

    She’d let them have a bath, give them a hot meal, wash and dry their clothes, and send them on their way with £20 and a packed lunch for later. She befriended international students. living in the uni halls of residence across the street. Sunday afternoons would find a stream of Chinese, Nigerian, Lebanese, Greek and every possible nationality of young student, walking to “Nanna’s House” for lunch, arms laden with gifts for her, chatting with people they probably never would have talked to.

    The fact that she and my granddad lived in a tiny one-bedroom bungalow did not dissuade her from inviting ever more lonely or hungry people. When we said we were worried about someone hurting or even killing her, she’d just say “I’d rather die because of trying to do something good for someone, than live forever ignoring people who are in pain or in need”.

    That was Lily. So when we tried to warn her about sCAM products and the opportunist lowlives that peddled them, she just didn’t believe they’d lie to her. Why, weren’t the staff in Holland and Barrett “…always so respectful and friendly? They wouldn’t lie to an old woman, or to me!”

    She didn’t think the law would allow these products to be sold if they were a rip-off. And unbeknown to us, in her last year she was taking all of her sCAM potions and RX’d medications, without telling her GP about the former or the sCAMsters about the latter, because she didn’t want either to believe that she didn’t trust them.

    Bullshit like the con-artist club that you linked to, Jeff, making billions by convincing people that there are “Lifesaving therapies” being hidden from them by mainstream medicine, is killing people. People scared of sickness, age and dying. People desperate for more time with their loved ones, who are being cynically preyed on and bled dry by promoters of woo like the LEF.

    They are filth. I want to dip my phone in bleach after viewing their disgraceful sales pitch on it. They help enrich the culture that supports Burzynski, Gerson, John of God etc. They provide countless warm bodies for the cult of the Brave! Maverick! Doctors!, who are being persecuted and silenced by the FDA, NICE, the MHRA etc.

    They make me wish that Hell was real. They make me so glad that places of science, people like the SBM bloggers, Orac, Ben Goldacre et al. are working hard to expose them for what they are, and the harm that they do.

    Sorry for the long comment everyone. After yesterday’s events I was primed for explosion, and this fool lit the fuse.

  34. The Dave says:

    “molasses as an iron source for energy”

    Does molasses have iron? yes. Does iron, in itself, work as a source for energy? no, it does not. It helps your blood transport oxygen

    A more likely source of the “extra energy” would be the sugar content:

    According to Wikipedia:

    “Each tablespoon of molasses (20 g) contains… 11.1 g of sugar divided amongst:[10]
    Sucrose: 5.88 g
    Glucose: 2.38 g
    Fructose: 2.56 g”

    Sucrose breaks down into glucose and fructose

    glucose produces ATP (The body’s energy source) by entering glycolysis, the TCA cycle, and oxidative phosphorylation

    fructose can be converted to glucose in the liver, which then produces ATP, as I briefly describe above.

  35. Ok..thank you The Dave, so then, she got energy from the sugar, and perhaps the iron helped her tinnitus then.

  36. Robb says:

    The review I linked covers 8 studies that used the same extract. Why do you say “Almost all the studies included were very preliminary with small numbers of subjects and inconsistent results” when the review concluded that all 8 showed significant benefit over placebo? The small numbers I can see – although they all meet a minimum of 50 usually required for statistical significance. Preliminary also doesn’t make sense since all 8 use the same extract. The first couple could be called preliminary, but how many need to be done before that word doesn’t apply?

    The other reviews, including the Cochrane review, have a number of flaws that are pointed out – the fact that they included and lumped together trials with a number of different Ginkgo preparations of varying strength and dosage and that they included large trials where: “No personal contact between physicians and patients was required; as a consequence, the actual existence and identity of the patients could not be verified, nor was any medical or audiological examination performed.” Looking at the Cochrane abstract, it seems that it only covers 2 trials total (although the 2011 review says Cochrane covers 3). Some of the trials included in the 2011 review took place after the 2004 review as well.

    I do not have the training to feel confident in analyzing whether the results as reductions in dB levels are worthy or not but the author feels they are – then again, it looks like he has only ever published this one article. I can see shortcomings in all the reviews and I thought the 2011 one was at least correct in pointing out some of them in the previous reviews. Certainly analyzing one particular extract rather than a wide variety is a better approach. And I noticed the 2011 review also mispelled Ginkgo in a few places… :)

  37. WilliamLawrenceUtridge says:

    So let me get this straight…Big Pharma is bad, lies and just wants you to get sick because they’re evil and/or just want to make money. But Tinnitus Miracle, which charges $69.99 (but for a limited time, only $37!!!), without actually telling you what the product is and has put a lot of effort into fake positive reviews and social media endorsements (example, example, example, a href = “”>example) is a valuable source.

    By the way, the tinnitus miracle solution <a href = ""appears to be:
    * Supplements (of course)
    * Immune boosting (whatever that means)
    * The 4 point retraining program
    * Detoxification (of course)
    * Hypnotherapy

    Anemia is a cause of objective tinnitus, the extremely rare and easily diagnosed kind of tinnitus where the sufferer hears an actual noise that can be heard by other people. With this level of deficiency (70 g/l of haemoglobin when the cut-off for anemia is around 120 g/l) you would see far more obvious signs of anemia. At that point, you would be going to see your doctor for extreme exhaustion, tinnitus would be an afterthought.

    So iron deficiency is a potential cause of one rare and easily identifiable form of tinnitus, not all. It can be cured by a $37 book and a mixture of four kinds of quackery. And we should trust that source because they are not big pharma, have no data and certainly have zero profit motive.

    This is what happens when your skepticism is ideologically-driven rather than data-driven. I wonder how much those supplements cost compared to say, food? Because I’m betting that $37 doesn’t include supplements.

  38. Robb says:

    Actually, doing a little digging, Alexander von Boetticher, the author of the 2011 Ginkgo review is an ear, nose, and throat surgeon from Germany. This particular ginkgo extract has been around since 1975 and is officially accepted and prescribed in Germany for tinnitus and various age related cognitive decline symptoms. Schwabe is actually a pretty impressive company for the work it’s done on herbal extracts – definitely puts to shame most of what is in North America.

  39. Robb – studies with a total of 50 or so subjects are borderline at best, and are considered preliminary. The studies in the review had mostly modest effects, barely statistically significant, with small numbers of total subjects, and various endpoints. I don’t care how many such studies you pile up – it’s not compelling.

    There are problems with all of the studies, but the biggest and best ones are negative. There is insufficient data to definitively say that Gingko does not work, but there is insufficient evidence to say that it does. The plausibility is also low. It’s probably not worth studying further, but since it is being recommended a large definitive trial would be interesting.

    I don’t see a problem with reviewing multiple formulas of Gingko in the same review, as long as they are looking at all the available studies.

    Herbalism is very popular in Germany, and I think they have a cultural blind spot for it. I tend to look at herbal studies coming out of Germany the same way I look at acupuncture coming out of Chiina – with extreme skepticism. They really need to clean up their act if they want to be taken seriously. Having said that – the studies are poor on their own merits, without considering their origin.

  40. mousethatroared says:

    “Anemia is a cause of objective tinnitus, the extremely rare and easily diagnosed kind of tinnitus where the sufferer hears an actual noise that can be heard by other people. With this level of deficiency (70 g/l of haemoglobin when the cut-off for anemia is around 120 g/l) you would see far more obvious signs of anemia. At that point, you would be going to see your doctor for extreme exhaustion, tinnitus would be an afterthought.”

    So we have a rare and poorly understood symptom that is well documented enough to know exactly what levels of defiency it occurs at?
    hmmm, that raises my skeptical red flag…although I don’t have time to look into it.

    How about we just say if you have tinnitus of unknown origin, maybe it won’t hurt to be tested for anemia. In my understanding, not a good idea to take iron supplements if you may not be deficient, though.

  41. mousethatroared says:

    Above was a quote from WLU

  42. Harriet Hall says:

    “not a good idea to take iron supplements if you may not be deficient, though.”

    No, it’s not a good idea. What if you have hemochromatosis (caused by iron overload) or iron deficiency anemia due to blood loss from undiagnosed colorectal cancer or bleeding ulcers, or anemia from an entirely different cause unrelated to iron?

  43. I would agree with that mouse..get tested for anemia.

  44. and personally, I would try a natural source of iron if I needed it like blackstrap molasses too.

  45. Robb says:

    Actually the biggest study was the worst methodologically, if I’m not mistaken (the one with 1200+ people that was just a mail out without any clinical testing at all and no way of knowing if the participants even followed the regimen properly). I agree the small ones don’t seem to be anything to get excited about but they did show some benefit and were of better design. The 2011 review also discusses the mechanism of action/plausability aspect. I can’t see the full Cochrane study – even the references for the 2 studies they covered – but I would hope it wouldn’t have been the one with 1200 people. I’m not pushing this because I really care that much whether ginkgo works for tinnitus especially (I’d be curious to see a large trial though) but more just as an exercise in what some of the pros and cons of the different studies and reviews are.

  46. Robb says:

    Also – the point about most of the studies being from Germany is an interesting one – and I’ve seen it used before trying to discredit SJW studies as well but ultimately, as you brought up, it shouldn’t matter as it’s the merits of the studies that are the most important. That same criticism is also levelled against use of pharmaceuticals based on industry sponsored studies, except in this case it would be much more dilute, being a potential national cultural bias rather than a private corporate one. In any case, we all have biases, conditioning, preconceptions, belief systems, etc. and as much as we may attempt to have our beliefs mirror reality, the map is not the territory and sometimes we are surprised. Best we can do is be aware and vigilant for how our beliefs/preconceptions may be influencing us.

    As a side note, I think this Ginkgo biloba extract is a good example of how the lines between herb and drug are blurred in reality. It is more of a spectrum than a division. This EGb 761 extract is standardized for three different constituents and in the process removes certain impurities from the herb. It’s kind of like drug development except it moves laterally as well in incorporating various fractions of the herb that have beneficial effects together.

  47. trrll says:

    I don’t have tinnitus–unless I listen for it. If I actively listen, I find that I am hearing a constant high-pitched sound. In fact, it’s rather loud. But it would have never occurred to me to seek treatment for it, because as soon as I get distracted and stop forget to pay attention to it, I stop being aware of it. I have no way of knowing if it started at a particular age, or if it’s always been there. Indeed, I have a theory that the common loss of high frequency hearing in older adults is not because of loss of sensitivity, but because it is drowned out by tinnitus. The sound I hear (when I think to listen) is up there around maybe 15-17 kHz, which is in the range of sounds that I used to be able to hear, but no longer can. I suspect that the difference between people who complain of tinnitus and those who do not isn’t in whether they hear it, but rather how well they habituate. Indeed, there are a wide range of real environmental sounds that I don’t hear unless I actively listen. In certain weather, my neighborhood is on an approach route to the airport, and I have some neighbors who complain about the disruptive noise of the planes. I don’t notice them at all unless somebody mentions them to me.

  48. Robb says:

    Yeah, it’s a bit of weird one – tinnitus and hearing loss do seem to often go hand in hand – and with the causes of it being so wide ranging and the physical pathology, if present at all, varying as well, it’s not surprising that there isn’t an effective treatment. A potential treatment could work for some in some cases but then do absolutely nothing for cases where it’s caused by something else.

  49. mousethatroared says:

    I enjoyed SN’s piece, but it occurs to me that many people have thoughts about tinnitus that could be addresses by a more general patient information article. This one seems to be pretty good if people want to get some background on tinnitus.

  50. WilliamLawrenceUtridge says:

    MTR, the sources I used to demonstrate tinnitus is a rare symptom of iron deficiency are all mainstream, legitimate ones (eMedicine and the National Institutes of Health), in contrast to the conflict-of-interest-ridden “magic supplements” one that Rustie got her quacky info from. The 120g/l is a standard cut-off used to define anemia. The 70g/l is the threshold given at which point the NIH source says chronic anemia produces unusual symptoms like tinnitus. Chances are if your tinnitus is due to iron deficiency, you’re more concerned over being too tired to do much, and unable to get enough oxygen. So it is true that iron supplements are sometimes a valid treatment for tinnitus, but situations they are warranted would be bleedingly obvious (extreme fatigue, gasping and audible noise coming from the ear itself). Iron is not a rational recommendation for tinnitus in general.

    Apologies if I’m missing sarcasm.

  51. mousethatroared says:

    How does NIH know that tinnitus appears at 70gl and not 80gl, 90, 110?

  52. BillyJoe says:


    “How about we just say if you have tinnitus of unknown origin, maybe it won’t hurt to be tested for anemia.”

    How about we first see if there is evidence that testing for anaemia is worthwhile in someone with tinnitis.
    After all, we are promoting SBM here aren’t we?

    RH: “I would agree with that mouse..get tested for anemia.”

    The kiss of death.

  53. WilliamLawrenceUtridge says:

    I don’t know how the cut-offs were established, the NIH article on anemia notes that the 120g/l figure is a relatively arbitrary cut-off and the clinical review for anemia mentions tinnitus only once and does not have a reference:

    The symptoms accompanying iron deficiency depend on how rapidly the anaemia develops. In cases of chronic, slow blood loss, the body adapts to the increasing anaemia, and patients can often tolerate extremely low concentrations of haemoglobin—for example, < 70 g/l—with remarkably few symptoms. Most patients complain of increasing lethargy and dyspnoea. More unusual symptoms are headaches, tinnitus, and taste disturbance.

    The article you linked to describes what sounds like objective (what I would call “an actual sound”) tinnitus and links it to anemia:

    Pulsatile tinnitus (tinnitus that beats with your pulse) can be caused by aneurysms, increased pressure in the head (hydrocephalus), and hardening of the arteries. Anything that increases blood flow or turbulence such as hyperthyroidism, low blood viscosity (for example, anemia), or tortuous blood vessels may cause pulsatile tinnitus. Vitamin B12 deficiency is common in tinnitus patients.

    So apparently anemia thins the blood and this causes increased blood flow or turbulence within the vessels leading to tinnitus that can be heard by patient and doctor. Which again goes back to iron supplementation being a science-based treatment for one very uncommon form of tinnitus, and certainly not represent a general treatment in the absence of deficiency.

    It’s amusing that blackstrap molasses is treated as a “natural” source since I believe the iron is present due to being leached out of the machinery during processing. It’s also non-heme iron, and comes with a lot of calcium which interferes with iron absorption. So, not particularly natural, and not a particularly good source of iron, and not a general treatment for tinnitus. Meat is a far more natural source, and is far better absorbed.

  54. mousethatroared says:

    WLU – My apologies for giving you a hard time. My point never was that we should arbitrarily take iron supplements or molasses for tinnitus. In fact I did note that it wasn’t a good idea. It’s just that evidence that a symptom is NOT caused by a particular ailment/disease often jumps out at me. Just my life experience and “the secret” effect, I guess.

    If something is rare and not particularly painful or deadly, it’s unlikely that it will be well researched. The 70g/l guideline may very well be based on consensus of doctors, who had to kinda guess. So I think it’s good to be aware of the quality of that evidence and not over or under estimate it. If a person’s tinnitus has the characteristics of anemic tinnitus, but their levels are at 100g/l, does it make sense to insist that the tinnitus is not caused by the anemia because they are not experiencing extreme fatigue and shortness of breath? As a patient, I wouldn’t be happy with that conclusion.

    On the other hand, If I’m a hardy male drummer with hearing loss and tinnitus and no other physical symptoms, after reading your information and the article I linked to, I would have no problem if my doctor didn’t order any blood work and I certainly wouldn’t take any form of additional iron to try to get rid of the tinnitus.

    As an aside – RH seemed to be misreading KirkMC reference to ‘periods of tinnitus’ as tinnitus that increases with periods (menstruation). I did the same thing because how the sentence was written, then corrected because I thought I remembered that KirkMC was a guy. So in my mind her anemia guess wasn’t 100% off.

    As another aside – RH was talking about a woman who was going through chemo, the references note that tinnitus may also be the result of some medications. If I were that woman, I would probably ask my doctor about that as well as anemia.

    Also, I am anemic (not sure if it’s due to iron deficiency), have no tinnitus (although it would be easy for me to think I do because my monitor emits a very faint high pitched whine) but have a brilliant recipe for molasses cookies. What should I do? ;)

  55. mousethatroared says:

    BillyJoe “How about we first see if there is evidence that testing for anaemia is worthwhile in someone with tinnitis.
    After all, we are promoting SBM here aren’t we?”

    BillyJoe – the evidence for when to test for anemia associate tinnitus is in the links that WLU and I posted. If you check out any of the links you’ll see a looooong list of known causes of tinnitus and tests. NO, I don’t think everyone should have every one of those tests. When I said “maybe it won’t hurt to test” I meant “maybe” depending upon the whole clinical picture of the patient with tinnitus. I just don’t happen to think that a doctor should rule out the possibility of tinnitus associated with anemia because the patient’s levels are above 70g/l and isn’t reporting extreme fatigue and shortness of breath.

    I realize it’s a nitpick – but in my experience one sometimes has to be nitpicky when getting to the root of a troublesome symptom.

    Also, I’m sure that RH and I agree on many things. In this case, it seems our agreement is partial at best. But, If RH agrees with me that jumping off a cliff is a bad idea, I wouldn’t think that should be considered to be good evidence that jumping off a cliff is NOT a bad idea.

  56. mousethatroared says:

    Also BillyJoe – I thought I said this before, but maybe I didn’t.

    MY goal here is not to promote SBM, my goal is to learn and advocate for good quality patient care, from a patient’s and a parent of a patient’s perspective. It often happens that I see SBM as an excellent tool in offering good quality patient care. In those cases I’m happy to say so.

    If at any time I see SBM as undermining good quality care, I’ll be sure to throw SBM under the bus as quickly as reasonably possible. Sorry guys, I like you, but those are my priorities.

  57. WilliamLawrenceUtridge says:

    No worries, I value your commentary and wanted to make sure I wasn’t missing something or being unclear. I thought I was being clear that iron supplements are not generally warranted for tinnitus bar one specific kind, if my point is clearer now then that’s better. I would suspect that doctors would diagnose anemia-related tinnitus mostly by being able to hear the noise themselves, the sharpest distinction between types of tinnitus seems to be between objective and subjective variants.

    You should bake your cookies and eat them because they are delicious – not pretend they are medicine :)

  58. mousethatroared says:

    WLU – Thanks for being a good sport!

    I know, one of my pet peeves is people who confuse food (or delicious herbal teas, for that matter) for medicine. To me it just takes a lot of the joy out of the food experience.

    Unfortunately, if you actually have a deficiency and prefer to correct it with food rather than supplements, then you get put in the position of having to look for particular foods and eat a certain amount of them daily, which is kinda treating them like medicine.

    Luckily, I’ve found an acceptable solution for iron. A particular kind of malt-o-meal is fortified with 70% RDA iron. It also has a good amount of fiber, which is something else I need, and is tasty. If I eat that for breakfast most days and then the rest of my diet really should get me up to around 100% RDA, which shouldn’t hurt me if my mild anemia isn’t iron related, but is nice insurance if my mild anemia is iron related.

    So molasses cookies are just gravy (unfortunate unappetizing metaphor).

  59. WTU..thanks for that info regarding molasses and iron..

    and mouse… ((and when I get periods when it’s really annoying)) that is what I thought it was, menstrual cycle/low iron.. LOL kirk is a guy. sorry pretty funny :)

  60. sddjnk says:

    As a sufferer from tinnitus from both Menieres and noise induced life, I find masking along with low dosage Diazepam about as effective as anything. Although with a 65dB right ear hearing loss, I have my “companion” with me always. The idea that homeopathic or naturalistic cures play to hopes and dreams. I have sympathy to all, but it is better to pursue adaptive therapy and masking than think Gingko, Niacin,… as the cure.

  61. BillyJoe says:


    I knew I should have put in those smilies. :)
    Oh, and did you miss my postage stamp opinion:


  62. Jeff says:

    One study concluded that tinnitus results from the brain producing sounds to replace those missing due to hearing loss:

    One multi-component nutraceutical is being researched as a treatment for returning U.S. soldiers suffering from tinnitus:

    The nutritional substances mentioned in both this article and the previously mentioned LEF article have two important advantages over most experimental drugs. They are available OTC, and come without serious potential side-effects. This means tinnitus sufferers could safely experiment with them to determine if they produce any improvement.

  63. shawmutt says:

    Between my tinnitus and my son’s severe eczema, I simply get bathed in woo when trying to research the maladies online. I’ve had tinnitus since at least 16, when I went to the MEPS center for my military physical and the higher tones from the hearing test blended in with the ringing in my ears. That was many years ago, but I remember the harder I tried to hear the tones the louder the ringing in my ears got. I blame the .22 revolver I used to shoot without ear protection. These days the ringing has become louder, and there is sometimes clicking noises along with the ringing. I get funny looks when I go out to parties, weddings, or music events wearing earplugs, but I have to try and protect the little hearing I have left.

    The only thing that really works for me is to never be in silence. I always have music playing or am around some other background noise. When I go to bed I run a small fan for a little white noise. The necessary quiet times are hard to deal with. Hunting is torture–as I’m sitting still and listening for the rustle of critters my ears are singing.

  64. Newcoaster says:

    Reading through some of the above descriptions, I think it must be different for everybody, so here (?hear) is my anecdote. Interesting how many SBM regulars have this condition.

    I woke up one day earlier this year..January 6 to be precise… with high frequency hearing loss in my left ear, that was replaced by tinnitus, a constant hissing/humming, like the noise in between radio stations. I also had severe vertigo for several days. My wife thought it was because we’d tested out the new surround sound with Star Wars on Blueray the night before. I, of course, assumed it was a temporary viral thing but when 3 weeks later nothing improved, I finally saw an ENT who said if I’d come in right away, sometimes high dose steroids help. He did “helpfully” tell me that stress and anxiety could make it worse. There may be something genetic as I have a sister with Meniere’s and a brother with intermittent tinnitus.

    Mine is there all the time, but sometimes it is relatively quiet, or more likely I’m just busy and distracted and can ignore it. Sometimes it is screaming loud and drowns out other sounds. There are restaurants I can’t go to anymore because they are so noisy, and ambient noise in general seems to dial up the tinnitus to the point I can’t have a conversation. I can’t go to parties as more than one person talking at once also cranks the tinnitus dial to 11. (I finally have a good excuse not to go to parties other than I’m a misanthropic curmudgeon and don’t like to go to parties!) I’m a big music fan, but have to admit that I don’t enjoy it as much anymore without the stereo effect. I can still detect low frequency sounds, but if too loud, they can almost be painful.

    I’ve always appreciated silence, and now more than ever, though I no longer experience true silence, given the constant noise my own brain is creating. However, I do hit the mute button for commercials on TV. I always found the audio in commercials louder and more jarring than the show, and even moreso now. I listen to podcasts more than music in my daily commute.

    There is one odd part of my experience. There is an occasional different sound…sort of like a very high pitched but musical squeaking pinging or popping, like a drop of water hitting a pool, but higher pitched and repetitive. It’s very brief, lasting only a few seconds, and comes on randomly. I actually find those somewhat “pleasant”, almost like an itch that is being scratched, or perhaps it gives me a brief hope that things will return to normal one day.

    Most people knowing me to be a skeptical physician have not offered any CAM advise, though one physician colleague did recommend acupuncture, and sent me a youtube link as evidence. I feel sorry for her patients if that is how she does research. I haven’t tried any conventional treatments yet, other than 10 days of prednisone after I saw the ENT. I have avoided tinnitus support groups etc because I seem to have adapted. Also my experience with support groups for other ill defined and hard to treat conditions (eg Fibromyalgia) has convinced me that people tend to get worse. They become focused on their symptoms, and there is a one upsmanship of who is worse than who else.

    I’ve avoided looking for conventional treatments as I don’t want to become one of those people pestering their doctor. Thanks Steve, for the summary of conventional wisdom and treatments. I think I’ll just wait and see.

  65. lilady says:

    Look like a spammer above, to me.

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