Which peer‑reviewed meta‑analyses evaluate Ginkgo biloba, alpha‑lipoic acid, B12 and magnesium for tinnitus or auditory neuropathy?
Executive summary
Peer‑reviewed meta‑analyses and systematic reviews most clearly exist for Ginkgo biloba in tinnitus, with multiple Cochrane and journal reviews concluding little or no reliable benefit (or conflicting low‑quality signals) [1] [2] [3] [4]. Broader network meta‑analyses of pharmacologic and antioxidant approaches include Ginkgo and group antioxidants (and list α‑lipoic acid among interventions), but the provided reporting does not identify standalone, peer‑reviewed meta‑analyses dedicated solely to α‑lipoic acid, vitamin B12, or magnesium for tinnitus or auditory neuropathy [5] [6] [7].
1. Ginkgo biloba — the literature that exists and what meta‑analyses say
Ginkgo biloba has been the subject of multiple systematic reviews and meta‑analyses: classic Cochrane and later systematic reviews concluded that evidence is limited and does not reliably show benefit when tinnitus is the primary complaint, while other reviews and some trials report mixed or small effects depending on product, dose and study quality [1] [2] [3] [4]. Large network meta‑analyses and pooled analyses that include Ginkgo among many interventions present inconsistent results: some network analyses rank antioxidant strategies including Ginkgo favorably on certain outcomes, but those findings are tempered by heterogeneity in preparations, small trials and risk of bias [5] [6]. In short, Ginkgo is the single agent with the most meta‑analytic attention in the supplied sources, but consensus reviews generally conclude the overall quality of evidence is low and benefit — if any — is small and inconsistent [1] [2] [3].
2. α‑Lipoic acid — included in trials and NMAs but no dedicated meta‑analysis in these sources
α‑Lipoic acid appears repeatedly in combination trials and is listed among antioxidant interventions examined in broad network meta‑analyses of tinnitus pharmacotherapy, but the available reporting shows α‑lipoic acid chiefly as a component of multi‑agent formulations or as one of many interventions in an NMA rather than the subject of its own peer‑reviewed meta‑analysis MagnesiumVitaminB6_Methylcobalamin_Vitamin_E_and_Chromium_Picolinate_in_the_Patients_of_Sudden_Sensorineural" target="blank" rel="noopener noreferrer">[8] [4] [5]. Animal and mechanistic studies cited in antioxidant trials support a rationale for α‑lipoic acid protecting hair cells from oxidative stress, and randomized trials sometimes test it combined with other antioxidants, yet no standalone meta‑analysis of α‑lipoic acid for tinnitus or auditory neuropathy is evident in the provided material [7] [8].
3. Vitamin B12 — plausible mechanism, limited pooled analysis evidence in these reports
Vitamin B12 is repeatedly discussed as biologically plausible given neurologic and vascular roles and is frequently measured in clinical trials, but the provided reports do not show a peer‑reviewed meta‑analysis focused solely on B12 for tinnitus or auditory neuropathy [7] [9]. Surveys and narrative reviews note its frequent use among patients and its study within broader vitamin panels, yet systematic reviews emphasize that vitamin supplementation trials are heterogeneous and have not produced convincing, generalizable pooled evidence for routine use [7] [9].
4. Magnesium — signal in observational and small trials, but no dedicated meta‑analysis shown here
Magnesium is cited as associated with tinnitus in observational studies and to have some protective effects in noise‑exposure trials; some small clinical studies suggest possible benefit, but the supplied sources do not report a dedicated peer‑reviewed meta‑analysis of magnesium alone for tinnitus or auditory neuropathy [10] [9] [11]. Network and umbrella reviews that examine “antioxidants” or broad supplement strategies may include magnesium among many agents, but those pooled analyses are not equivalent to a focused meta‑analysis of magnesium efficacy [5].
5. What this means for clinicians, patients and for commercial claims
The strongest and most consistent meta‑analytic attention in the supplied material is directed at Ginkgo biloba, and that body of work largely finds little reliable benefit for primary tinnitus complaints or at best conflicting, low‑quality signals; broader NMAs include antioxidants such as Ginkgo and α‑lipoic acid as potentially promising but limited by heterogeneity [1] [2] [5] [6]. Commercial marketing and supplement reviews enthusiastically cite selective positive trials or mechanistic rationale (for example Audifort and other product pages), which can overstate certainty compared with systematic reviews and practice guidelines that advise caution [12] [11] [9]. The supplied reporting does not provide peer‑reviewed, standalone meta‑analyses for α‑lipoic acid, vitamin B12 or magnesium in tinnitus/auditory neuropathy, so any assertion about those agents’ pooled efficacy would exceed the bounds of the provided evidence [8] [7] [10].