Lidocaine for Tinnitus Relief: Meta-Analysis

A systematic review and meta-analysis pooling data from 550 participants across 12 studies has concluded that the local anesthetic lidocaine may offer temporary relief for some aspects of tinnitus, but its overall effect on severity remains unclear. The analysis, led by Anas Alashram and published in Egyptian Journal of Otolaryngology, found the collective evidence on lidocaine for tinnitus treatment to be mixed and preliminary.

How Researchers Assessed Lidocaine’s Effects

To build a comprehensive picture, the researchers searched six major scientific databases from their inception until November 2025. They focused exclusively on randomized controlled trials, the gold standard for clinical evidence, where lidocaine was administered to treat tinnitus. Outcomes were measured using validated tools like the Tinnitus Handicap Inventory (THI) and Visual Analog Scales (VAS) for tinnitus intensity.

Each study’s quality was evaluated using the Cochrane Risk of Bias 2 tool. Of the 12 included studies, four were judged to have a low risk of bias, while eight raised some methodological concerns. This mix of study quality, combined with significant differences in how the trials were run, introduced complexity into the analysis.

Meta-Analysis Shows No Clear Win for Severity Scores

The core of the review was a statistical meta-analysis combining results from multiple studies. For the two primary outcome measures—the THI and VAS for tinnitus intensity—lidocaine failed to show a statistically significant effect.

The mean effect size for the THI was 0.358, but the confidence interval crossed zero (95% CI: -0.092 to 0.809), indicating the result could be due to chance. Similarly, the VAS intensity score showed an effect size of 0.145 (95% CI: -0.398 to 0.687). The high I² scores of 77% and 79%, respectively, signal substantial heterogeneity among the studies, meaning the results varied widely from one trial to another.

This suggests that, on a group level, lidocaine administration does not reliably move the needle on overall tinnitus severity as captured by these standard questionnaires. This finding aligns with the complex nature of tinnitus, where a single pharmacological agent like lidocaine is unlikely to be a universal solution, much like other approaches such as neuromodulation for tinnitus which also show varied results.

Glimmers of Potential in Specific Tinnitus Features

While the overall severity scores didn’t show a clear benefit, the review noted promising signals in other areas. Several individual studies reported that lidocaine, particularly when given intravenously or via intratympanic injection directly into the middle ear, could temporarily alter specific characteristics of the tinnitus percept.

These included reductions in the perceived pitch and loudness of the sound, as well as a decrease in the distress it causes. Some studies also noted improvements in pure-tone hearing thresholds. This indicates lidocaine might be modulating the hyperexcitability in auditory pathways, a mechanism shared with some forms of targeted brain stimulation.

The transient nature of these effects, however, points to a temporary dampening of symptoms rather than a cure. This temporary relief could be conceptually similar to the immediate sound-based relief provided by acoustic masks, though the mechanisms are fundamentally different, as explored in our article on acoustic masks vs cochlear implant science.

Practical Implications and Future Research

The review’s conclusions are cautious. The significant heterogeneity—stemming from different doses, routes of administration (intravenous vs. intratympanic vs. topical), and patient populations—makes it difficult to draw firm clinical guidelines. Lidocaine is not currently a standard treatment for tinnitus, and these findings do not support a change in that position.

For patients, the main takeaway is that while lidocaine might briefly change how tinnitus sounds or feels for some individuals, the evidence is not strong or consistent enough to recommend it as a routine therapy. The search for effective management continues to focus on multidisciplinary approaches, including sound therapy and cognitive behavioral techniques, which can help with the distress that often accompanies tinnitus, a link explored in tinnitus, anxiety, and sleep.

Alashram and colleagues call for more standardized, high-quality research to clarify if specific subpopulations of people with tinnitus might benefit from lidocaine, and to determine the optimal dose and delivery method. Future studies must also carefully consider safety, as lidocaine carries risks, especially with intravenous use.

Ultimately, this review underscores a common theme in tinnitus research: a treatment may show promise for specific symptoms in some studies, but proving a broad, significant, and durable effect remains a significant challenge. The path forward lies in continued rigorous investigation and personalized treatment strategies.

Source: Alashram, A. The effects of lidocaine on tinnitus symptoms: a systematic review and meta-analysis of randomized controlled trials. Egypt J Otolaryngol 42, 117 (2026).