Clinical efficacy of lidocaine in alleviating tinnitus symptoms: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Approximately 15% of individuals experience tinnitus worldwide. Lidocaine is a sodium channel blocker that reduces abnormal cellular excitability in the central nervous system. This review aims to investigate the effects of lidocaine on tinnitus symptoms. Methods “PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science” were searched from inception to November 2025. Randomized controlled trials that administered lidocaine and assessed tinnitus symptoms were included. The risk of bias was assessed using the “Cochrane Risk of Bias 2 (RoB 2) tool”. Results Twelve studies, including 550 participants, met the inclusion criteria. Four studies were rated as a low risk of bias using the RoB 2 tool, and eight studies had some concerns. The meta-analysis showed that lidocaine had a non-significant effect on tinnitus severity, with a mean effect size of 0.358 (95% CI: -0.092 to 0.809; p = 0.119; I² = 77%) for THI and 0.145 (95% CI: -0.398 to 0.687; p = 0.601; I² = 79%) for VAS-Tinnitus intensity. Other outcomes demonstrated that intravenous and intratympanic lidocaine may reduce tinnitus pitch, distress, and loudness, and improve hearing thresholds. Conclusions The initial findings suggest that lidocaine has potential effects in the temporary relief of tinnitus pitch and distress; however, the overall evidence remains inconclusive. These findings should be interpreted with caution due to heterogeneity in routes of administration, treatment protocols, and study populations. Future studies are needed to clarify the effects of lidocaine.