Lidocaine and Tinnitus
Lidocaine is a local anesthetic commonly used across a variety of clinical settings. It can be given intravenously to facilitate tracheal intubation, applied to the gums in dentistry to numb an area prior to a procedure, and administered during surgery to reduce pain and improve outcomes after the operation.1 Like other local anesthetics, lidocaine binds to sodium channels in nerve cells, preventing nerve depolarization and the transmission of a nerve impulse. Less commonly, lidocaine can be used to manage tinnitus.
Patients with tinnitus hear ringing or other noises without external sources. Often caused by hearing loss or an ear injury, tinnitus can be treated with sound therapies, cognitive behavior therapies, and medications that aid in sleep.2 However, there is no FDA-approved drug or treatment specifically for the condition. The need, however, is considerable: according to the American Tinnitus Foundation, 25 million Americans experience some form of the condition, with 2 million, or 8%, finding it debilitating.3
For decades, lidocaine has been observed to temporarily alleviate or dissipate the symptoms of tinnitus. In a 1978 study, the intravenous injection of lidocaine in 78 patients with tinnitus led to the complete disappearance of symptoms in 27 (35%), partial improvement in 22 (28%), and no observed change in 21 (26%).4 More recent studies have also demonstrated lidocaine’s positive impact. A 2018 study evaluated an injection of lidocaine with the steroid dexamethasone administered directly into the middle ear through the ear drum (known as an intratympanic injection). Compared to patients who received only dexamethasone, those who received the lidocaine-containing injection experienced improvements in their tinnitus symptoms, as measured by the loudness matching test, in which the volume of an external noise is adjusted to match that of the tinnitus, and the tinnitus handicap index, in which a patient quantifies the difficulties they are experiencing due to tinnitus.5
The mechanism by which lidocaine reduces tinnitus symptoms is not entirely clear, but it is thought to relate to the anesthetic’s ability to lower spontaneous hyperactivity in the central nervous system, which can itself be implicated in tinnitus.6 Furthermore, lidocaine can improve blood flow to the inner ear and reduce the cochlear microphonic, the electric potential generated by cochlear hair cells in response to sound.7
Despite its successes, using lidocaine to treat tinnitus remains imperfect. In fact, it may even have a worsening effect: in one randomized controlled trial, over 30% of patients with tinnitus had worsened symptoms.7 Lidocaine can also lead to other side effects, including prolonged numbness, tingling, and slurred speech.
Although lidocaine is not currently recommended for the treatment of tinnitus, recent new approaches in leveraging the anesthetic may help change this. In one study, participants with chronic tinnitus wore a lidocaine patch and had improved symptoms after several months of treatment.8 Though the sample size was small, this approach may help represent a new avenue of care for the millions struggling with tinnitus.
References
1. Beecham, G. B., Nessel, T. A. & Goyal, A. Lidocaine. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
2. What Is Tinnitus? — Causes and Treatment | NIDCD. https://www.nidcd.nih.gov/health/tinnitus (2023).
3. What is Tinnitus? | American Tinnitus Association. https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/ (2023).
4. Melding, P. S., Goodey, R. J. & Thorne, P. R. The use of intravenous lignocaine in the diagnosis and treatment of tinnitus. J. Laryngol. Otol. 92, 115–121 (1978), DOI: 10.1017/s002221510008511x
5. Elzayat, S. et al. Evaluation of Adding Lidocaine to Dexamethasone in the Intra-tympanic Injection for Management of Tinnitus: A Prospective, Randomized, Controlled Double-blinded Trial. Int. Tinnitus J. 22, 54–59 (2018), DOI: 10.5935/0946-5448.20180009
6. Kim, S. H. et al. Review of Pharmacotherapy for Tinnitus. Healthcare 9, 779 (2021), DOI: 10.3390/healthcare9060779
7. Duckert, L. G. & Rees, T. S. Treatment of tinnitus with intravenous lidocaine: A double-blind randomized trial. Otolaryngol. Neck Surg. 91, 550–555 (1983), DOI: 10.1177/019459988309100514
8. O’Brien, D. C., Robinson, A. D., Wang, N. & Diaz, R. Transdermal lidocaine as treatment for chronic subjective tinnitus: A Pilot Study. Am. J. Otolaryngol. 40, 413–417 (2019), DOI: 10.1016/j.amjoto.2019.03.009