Abstract
Standardized Ginkgo biloba extract (GBE) is an established herbal treatment used for a variety of indications, including vertigo and/or tinnitus. The evidence base in human clinical studies for a clear benefit of GBE in vertigo and/or tinnitus is limited and contradictory due to poor reporting as well as variations in study quality and outcome measures used. The aim of this review is to identify and discuss the rationale for using GBE in the treatment of vertigo and/or tinnitus based on the known pleiotropic actions of GBE and the pathophysiology of vertigo and/or tinnitus. The rationale will be substantiated by a review of the literature in order to identify and evaluate clinical trials investigating the efficacy of GBE in individuals with vertigo and/or tinnitus. The review identified randomized controlled trials (RCTs) investigating the effectiveness of GBE in vertigo and/or tinnitus published in PubMed up to 1st January 2020. In total, 17 RCTs were included 8 of the 9 studies investigating tinnitus and/or vertigo/dizziness found improvements, and 6 of 8 included studies investigating solely tinnitus showed positive effects. Based on the known mechanisms of action of GBE as well as evidence from animal models and human clinical trials identified in this review, GBE is a rational alternative treatment that might provide benefits to individuals with vertigo and/or tinnitus. However, further well-defined RCTs in patients with defined pathological entities are necessary to further substantiate the beneficial effects of GBE for vertigo and/or tinnitus.
Highlights
Maintaining balance and orientation depend on input from the visual and proprioceptive systems, the inner ear, and integration in the brainstem vestibular nuclei and the cerebellum [1]
The rationale will be substantiated by a review of the literature in order to identify and evaluate clinical trials investigating the efficacy of Ginkgo biloba extract (GBE) in individuals with vertigo and/or tinnitus
The two GBEs, EGb 761 and LI 1370, are deemed analogous products, and equivalence can be assumed based on ESCOPMonographs and the same amounts of the active ingredients flavonglycosides and terpenlactones [24] [65]
Summary
Maintaining balance and orientation depend on input from the visual and proprioceptive systems, the inner ear, and integration in the brainstem vestibular nuclei and the cerebellum [1]. Dysfunction of any of these systems can cause disorders of balance and the sense of orientation, often leading to complaints of dizziness and/or vertigo [2]. Many people with vertigo and/or dizziness complaints experience emotional, memory, and self-perception problems, which are especially common in the elderly [2]. Vertigo and/or dizziness is a common complaint, with an estimated 1-year prevalence between 40% and 50% in adults [5] [6]. Dysfunction of the vestibular system (vestibular vertigo) accounts for about a quarter of dizziness complaints and has a 1-year prevalence of 5% and an annual incidence of 1.4% [7]. Despite the considerable personal and health care burden of dizziness and vertigo symptoms, a large percentage of the underlying disorders remain under diagnosed and, are probably insufficiently treated [8]
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