We sell nothing for tinnitus and would not. That is exactly why it is worth writing about properly: there is nothing at the end of this article to buy, which makes it easier to report the evidence as it stands.
It stands in an awkward place. The best-supported treatment does not make the sound quieter, the most-sold supplement has been tested repeatedly with an unfavourable conclusion, and the most useful thing here is a list of situations needing urgent assessment.
Tinnitus is the perception of sound with no external source — ringing, hissing, buzzing, a high tone, sometimes a rushing. It is a symptom, not a disease, and in most people has no identifiable structural cause.
A 2022 meta-analysis in JAMA Neurology drew prevalence estimates from 83 articles. Pooled prevalence of any tinnitus among adults was 14.4% (95% CI 12.6–16.5) and of severe tinnitus 2.3% (1.7–3.1). It rose with age — 9.7% at 18 to 44, 13.7% at 45 to 64, 23.6% at 65 and over (P < .001) — and did not differ significantly by sex. Heterogeneity was substantial, individual estimates ranging from 4.1% to 37.2%, so treat the pooled figure as an order of magnitude.
Two things it generally is not. It is usually not a sign of a tumour: most cases are bilateral, symmetrical and tied to hearing change rather than anything structural. And loudness is not the problem. How loud tinnitus is and how much it ruins someone's life are only loosely related — which is why the best-evidenced treatment works on distress rather than volume, and why that is not a fudge.
Tinnitus and hearing loss travel together. Most people with persistent tinnitus have measurable hearing loss, often above the frequencies a basic screen tests. The prevailing explanation is that reduced input to auditory pathways produces increased spontaneous activity further up — the brain turning up its own gain on a signal that has gone quiet.
That matters beyond the ear. Untreated hearing loss is on the Lancet Commission's list of modifiable dementia risk factors, and we have written about what that association does and does not show, including a large randomised trial with a null primary result. Get your hearing tested because you cannot hear, not for a dementia argument that is suggestive rather than settled. Tinnitus is a good reason to have it done; the wider risk picture is here.
This is the part to act on. NICE guideline NG155 sets out when tinnitus needs more than reassurance.
Immediately: tinnitus with the sudden onset of significant neurological symptoms or signs — facial weakness, for instance — or acute uncontrolled vestibular symptoms. Separately, anyone whose tinnitus carries a high risk of suicide should be referred immediately to a crisis mental health team. Tinnitus-related distress can be severe, and that recommendation exists because it has to.
Within 24 hours: tinnitus alongside hearing loss that developed suddenly — over three days or less — within the past 30 days. Sudden sensorineural hearing loss is time-critical, treatment windows are measured in days, and this is the single most important sentence in this article.
Worth referring for assessment: persistent pulsatile tinnitus, a sound in time with your heartbeat, which can have a vascular cause; and persistent unilateral tinnitus, in one ear only.
None of that describes the common case. Most tinnitus is bilateral, gradual and unaccompanied. But the exceptions are the reason to have it looked at rather than assume.
A 2020 Cochrane review included 28 studies with 2,733 participants, all with tinnitus for at least three months.
Against no intervention or a waiting list, CBT may reduce the impact of tinnitus on quality of life: SMD −0.56 (95% CI −0.83 to −0.30), 10 studies, 537 participants, low certainty — on the Tinnitus Handicap Inventory, 10.91 points lower against an estimated minimal clinically important difference of 7 points. So it clears the bar.
The active comparisons are where honesty is required. Against audiological care, CBT probably reduces impact by 5.65 THI points (95% CI 1.50 to 9.79), 3 studies, 444 participants, moderate certainty — a real effect, but below that 7-point threshold. Against other active treatments such as relaxation or information, the effect was 5.84 THI points (SMD −0.30, 95% CI −0.55 to −0.05, 12 studies, 966 participants, low certainty) — again below it.
Two further caveats the reviewers stated plainly. All of those results are at the end of treatment; there was an absence of evidence at 6 and 12 months. CBT may slightly reduce depression, while the evidence for anxiety and general quality of life remains uncertain. Serious adverse effects appear rare.
NICE recommends a stepped approach for tinnitus-related distress in adults: digital tinnitus-related CBT provided by psychologists, then group interventions such as acceptance and commitment therapy or CBT, then individual CBT. Psychological therapy carrying the best evidence in a condition people expect to treat with a substance is a recurring pattern, as in insomnia and anxiety.
NICE is specific here, and the specificity is the useful part. Offer amplification to people with tinnitus whose hearing loss affects their ability to communicate. Consider it where there is hearing loss but no communication difficulty. Do not offer it to people with tinnitus and no hearing loss.
The trial evidence on tinnitus benefit specifically is thin: a Cochrane review found one randomised trial with 91 participants and concluded the evidence is limited. The case for treating hearing loss rests on hearing; any tinnitus benefit is a reasonable hope rather than a demonstrated outcome.
Worth reading carefully, because it is widely recommended and the evidence is weaker than almost anyone assumes. A 2018 Cochrane review of sound therapy — hearing aids, sound generators and combination devices — included 8 studies with 590 participants and found no data at all for any of its three main comparisons: devices versus waiting list, versus placebo, or versus information with no device. Only device-versus-device comparisons were possible. Combination devices versus hearing aids alone showed no difference (SMD −0.15, 95% CI −0.52 to 0.22, 3 studies, 114 participants, low quality). Both were associated with clinically significant reductions from baseline — which, with no untreated comparator, cannot be separated from natural improvement and placebo response.
The reviewers concluded there is no evidence supporting the superiority of sound therapy over waiting list, placebo or information with no device. The NICE committee reached the same impasse and was unable to make a practice recommendation, issuing a research recommendation instead.
That is not the same as saying it does not work. Many people find background sound easier to live with, and it is cheap and harmless — a comfort measure with an honest evidence gap behind it.
NICE is unambiguous: do not offer betahistine to treat tinnitus.
Tinnitus has a large supplement industry attached, for structural reasons: the condition is common, distressing, fluctuates on its own, and has no reliable medical cure. Ideal conditions for selling something, and for a placebo response — Cochrane reviewers here repeatedly warn that the subjective nature of tinnitus creates a strong likelihood of placebo effects. We have written about what that means for supplement trials.
Ginkgo biloba is the most-tested, and the answer has not changed. A 2013 Cochrane review of 4 trials with 1,543 participants concluded the limited evidence does not demonstrate Ginkgo biloba is effective for tinnitus when tinnitus is the primary complaint. A 2022 update included 12 studies with 1,915 participants: pooled symptom severity at three to six months, mean difference −1.35 on a 0–100 THI scale (95% CI −8.26 to 5.55), 2 studies, 85 participants, very low certainty; loudness by audiometric matching −4.00 dB (95% CI −13.33 to 5.33), 1 study, 73 participants; quality of life −0.58 (95% CI −4.67 to 3.51). Every confidence interval crosses zero. The authors concluded uncertainty about both benefits and harms, on evidence graded low to very low.
There is a fair reading and an unfair one. The unfair one is "proven useless": the trials are too small and too poorly blinded to prove anything. The fair one is that after two decades of testing nobody has produced a trial good enough to show a benefit. Ginkgo also carries a theoretical bleeding risk, which matters if you take an anticoagulant.
Zinc is the other commonly marketed option, and the position is similar: a Cochrane review found 3 trials with 209 participants, at moderate to high risk of bias, differing enough that no meta-analysis was possible.
Get a hearing test. Rule out the red flags. If tinnitus is affecting sleep, mood or concentration, ask about psychological therapy rather than waiting to be offered it — and if sleep is the pressure point, the 3am waking problem has its own answers. Use background sound if it helps, knowing its trial evidence is absent rather than negative. Protect your hearing from further noise.
And do not buy a supplement for it. Not ours — we do not make one, and nothing in our range is indicated for tinnitus. Not anyone else's either, on the evidence above. Our rule for what we will and will not sell is in why we do not sell brain blends, and tinnitus does not come close to clearing it. If someone is selling you something for this, how to read the label is more use than the claim on the front.
This article is not medical advice. If you have tinnitus with sudden hearing loss, neurological symptoms, a pulsatile quality, or in one ear only, see a clinician rather than reading on.
Sources: Jarach CM. Global prevalence and incidence of tinnitus. JAMA Neurol. 2022 · Fuller T. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 2020 · Sereda M. Sound therapy for tinnitus. Cochrane Database Syst Rev. 2018 · Hoare DJ. Amplification with hearing aids for tinnitus. Cochrane Database Syst Rev. 2014 · Sereda M. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev. 2022 · Hilton MP. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev. 2013 · Person OC. Zinc supplementation for tinnitus. Cochrane Database Syst Rev. 2016 · NICE NG155. Tinnitus: assessment and management