Which supplements for tinnitus have randomized controlled trials supporting any benefit?

1. Ginkgo biloba: the best-studied supplement — promising early reports, larger RCTs undercut claims

Ginkgo biloba is the single supplement tested most often in RCTs for tinnitus, with early smaller trials reporting benefit but larger, double‑blind, placebo‑controlled trials failing to show a meaningful effect — for example, a 1,121‑subject trial using 50 mg G. biloba LI 1370 three times daily for 12 weeks found no notable improvement versus placebo ^{[1] [2]}. Systematic reviews summarize conflicting results: some trials suggest benefit while higher‑quality studies do not, leaving the balance of randomized evidence inconsistent rather than supportive of a clear clinical benefit ^{[1] [2] [3]}.

2. Lipoflavonoid and manganese: a high‑profile negative randomized trial

Lipoflavonoid (a vitamin/flavonoid compound) has been heavily marketed to tinnitus sufferers, but the only rigorous randomized study that tested Lipoflavonoid Plus alone or with manganese showed no meaningful reduction in tinnitus compared with control, and critical reviews and patient‑survey data report no consistent benefit and some adverse effects ^{[8] [9] [4] [3]}. Independent reviewers have labeled much marketing around these products as unsupported by the RCT evidence ^{[9] [3]}.

3. Other supplements with some randomized evidence but weak or mixed signal

A small number of RCTs have evaluated melatonin, zinc, vitamin B12 and other antioxidants or “food supplements”; results are heterogeneous, with many trials negative or underpowered and meta‑analyses concluding insufficient evidence to recommend these agents ^{[4] [10] [6]}. A network meta‑analysis that pooled many RCTs highlighted antioxidants (including ginkgo) and acamprosate as potentially promising compared with other pharmacotherapies, but it also emphasized the need for larger, higher‑quality trials — a signal, not proof ^[5].

4. Proprietary or single‑study positives: enzymolyzed honeybee larvae and mixed food‑supplement trials

Some single randomized or single‑blind trials report symptomatic benefit for unusual proprietary supplements — for example, a Japanese double‑blind trial reported benefit from enzymolyzed honeybee larvae, and a recent trial reported a food supplement improving tinnitus when comorbid with headaches — but these results come from isolated studies with limited replication and therefore cannot establish reliable clinical efficacy ^{[5] [11]}. Clinical guideline reviews treat such single positive RCTs cautiously and do not endorse supplements broadly ^{[6] [7]}.

5. How guideline reviews and surveys judge the totality of randomized evidence

Comprehensive reviews and guideline‑level analyses repeatedly find low strength of evidence that supplements reliably reduce tinnitus severity, and conclude that cognitive‑behavioral approaches and sound therapies have more robust support for improving quality of life than dietary supplements; where RCTs exist, results are usually inconsistent or insufficient to recommend routine supplement use ^{[6] [7] [12]}. Patient surveys show most supplement users report no effect and a nontrivial minority report harms, reinforcing caution ^[4].

6. Commercial and research‑agenda context: why confusion persists

The supplement marketplace, pervasive advertising, and small positive trials have created the perception of a “magic pill” despite the randomized evidentiary base being weak or mixed; reviewers and advocacy groups warn that marketing often outpaces reproducible RCT evidence and that some marketed products have only a single negative RCT or low‑quality positive trials ^{[3] [9] [2]}. Major systematic efforts call for larger, better‑designed randomized trials if supplements are to be recommended for tinnitus ^{[5] [6]}.