Each year, millions of Americans develop tinnitus—an irritating condition that causes phantom sounds like ringing, buzzing, or whistling in the ears. In fact, it ranks as one of the most common types of hearing disturbances. The exact causes of tinnitus are unclear. Researchers suspect it’s linked to loud noise exposure, certain medications, ear infections and earwax, and head or neck injuries. The vast majority of tinnitus cases are due to underlying hearing loss.

Bhatt JM, Lin HW, Bhattacharyya N. Tinnitus epidemiology: prevalence, severity, exposures and treatment patterns in the united states. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959-965.

Yeh CW, Tseng LH, Yang CH, Hwang CF. Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial. Biomed J. 2019;42(1):46-52.

 

Some people have also reported tinnitus during or after being diagnosed with COVID-19. According to evidence, viral infections—particularly respiratory viruses—are known to cause inner ear symptoms that may contribute to tinnitus. While the surge in COVID-19 cases may have impacted the prevalence of tinnitus, the recent increase in social isolation and changes in health-seeking behavior during the pandemic may have contributed to the condition as well, according to Tina Munjal, MD, a resident physician and postdoctoral fellow in the Department of Otolaryngology - Head & Neck Surgery with Stanford Medicine, told MDLinx.

Jafari Z, Kolb BE, Mohajerani MH. Hearing loss, tinnitus, and dizziness in covid-19: a systematic review and meta-analysis. Can J Neurol Sci.:1-12.

Figueiredo RR, Penido N de O, de Azevedo AA, et al. Tinnitus emerging in the context of a COVID-19 infection seems not to differ in its characteristics from tinnitus unrelated to COVID-19. Front Neurol. 2022;13:974179.

 

Because there is no cure for tinnitus, some patients may be interested in exploring alternative treatments, including nutritional supplements. Zinc, an essential mineral involved in immune function, cell signaling, and wound healing, often makes the list of tinnitus natural remedies; however, the science of its powers is limited. 

As a result, healthcare providers are hesitant to recommend zinc supplements to patients — unless they have a diagnosed zinc deficiency. “There is no high-quality evidence demonstrating a direct positive impact of zinc on tinnitus, particularly in those without a pre-existing zinc deficiency,” Dr. Munjal told MDLinx. 

 

The relationship between zinc and hearing

 

Zinc plays a role in many body functions, including immune responses, neurological processes, and growth and development. Studies have found high concentrations of zinc in the cochlea, which is located in the inner ear, and vestibular sites. Zinc deficiency may also contribute to auditory conditions — for example, a lack of zinc has been linked to hearing loss in older adults, along with olfactory disturbances and tinnitus.

Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG. Review of pharmacotherapy for tinnitus. Healthcare (Basel). 2021;9(6):779

Kentaro Ochi, Toru Ohashi, Yutsugi Kinoshita, et al. Serum zinc levels in tinnitus patients. Bulletin of the Japanese Otorhinolaryngological Society. 1997;100(9):915-919.

 

Some researchers suspect that, because of the connection between zinc and the ear, along with its antioxidant and anti-inflammatory properties, the mineral may help treat ear conditions such as tinnitus. “Tinnitus patients with pre-existing zinc deficiency may benefit; however, tinnitus patients with normal zinc levels may not,” says Dr. Munjal. Not all patients with tinnitus have a zinc deficiency.

Jarosz M, Olbert M, Wyszogrodzka G, Młyniec K, Librowski T. Antioxidant and anti-inflammatory effects of zinc. Zinc-dependent NF-κB signaling. Inflammopharmacology. 2017;25(1):11-24.

 

 

 

How zinc may impact tinnitus symptoms

 

The evidence on zinc’s ability to alleviate tinnitus is limited, mixed, and controversial. “Some studies have suggested potential benefits, particularly in cases of zinc deficiency, but more research is needed to establish its role as a primary treatment,” says Geoff Trenkle, DO, the CEO and founder of the Los Angeles Center for Ear, Nose, Throat and Allergy.

Yeh CW, Tseng LH, Yang CH, Hwang CF. Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial. Biomed J. 2019;42(1):46-52.

 

A 2016 analysis evaluating three trials involving a total of 209 participants concluded that oral zinc supplementation didn't appear to ease tinnitus symptoms. Two of the reports included in the analysis determined that zinc did not affect tinnitus. The third study found the majority of participants self-reported noticeable improvements in their tinnitus symptoms.

Person OC, Puga ME, Silva EM da, Torloni MR. Zinc supplementation for tinnitus. Cochrane Database of Systematic Reviews. 2016;(11).

 

 

Arda HN, Tuncel U, Akdogan O, Ozluoglu LN. The role of zinc in the treatment of tinnitus. Otology & Neurotology. 2003;24(1):86.

 

More recently, a 2022 study determined that zinc serum levels didn’t appear to influence the development of tinnitus. And a 2019 study found that zinc supplements boosted zinc serum link levels and improved tinnitus symptoms in people with noise-induced hearing loss-related tinnitus. “The researchers found that tinnitus scores improved after therapy, but importantly, there was no placebo group to serve as a control. This severely limits the ability to make generalizations based on these data,” says Dr. Munjal. All in all, zinc’s effectiveness is not universally established, says Dr. Trenkle, and its impact may vary from person to person.

Micronutrients in tinnitus: a national health and nutrition examination survey analysis. American Journal of Otolaryngology. 2022;43(3):103460.

Yeh CW, Tseng LH, Yang CH, Hwang CF. Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial. Biomed J. 2019;42(1):46-52.

 

 

Should doctors recommend zinc for tinnitus?

 

There is no cure for tinnitus, however, various interventions are available to reduce the severity of symptoms. Sound therapy, including hearing aids and sound generators, are commonly used to lessen the impact of tinnitus, according to the National Institutes of Health. In addition, behavioral therapy, such as cognitive behavioral therapy (CBT) and tinnitus retraining therapy, can teach people coping techniques and strategies that may improve their well-being. CBT helps restructure negative thoughts pertaining to tinnitus, explains Dr. Munjal.

In some cases, medications, like antidepressants and anti-anxieties, may be prescribed to address the mental health effects linked to tinnitus. Because tinnitus can be difficult to treat and, for some, eliminate, many patients are interested in exploring alternative options such as zinc supplementation. 

Liu D, Hu Y, Wang D, et al. Herbal medicines in the treatment of tinnitus: An updated review. Front Pharmacol. 2023;13:1037528.

 

Dr. Trenkle says there is likely a role for zinc, but he would not recommend it as a stand-alone treatment for tinnitus. The American Academy of Otolaryngology—Head and Neck Surgery Foundation explicitly advises healthcare providers to avoid recommending zinc to patients with tinnitus. “Doctors should not routinely recommend zinc supplementation to patients with tinnitus unless the patient has a known documented zinc deficiency,” says Dr. Munjal. 

For patients only experiencing tinnitus, however, doctors should refer patients to an audiologist for a full hearing examination, says Dr. Munjal. They can offer treatments, potentially identify any abnormalities in the ear canals, and, if necessary, work with an otolaryngologist to facilitate additional testing. 

Tinnitus is a complex condition that has multiple potential root causes. Because of this, medical advice must be personalized for each patient. We don’t fully understand the link between zinc and the inner ear, however, future research may identify new and alternative treatments that can effectively address tinnitus. “Ongoing research continues to shed light on potential treatments and their effectiveness in addressing tinnitus,” Dr. Trenkle said.