The Role of Low-Level Laser Therapy in Tinnitus Treatment
Often described as ringing or hissing in the ears, tinnitus is unpleasant and sometimes incapacitating.
Tinnitus, commonly described as ringing, buzzing or hissing in the ears, affects an estimated 750 million people worldwide. While it is considered a symptom rather than a disease, tinnitus can range from mildly irritating to severely debilitating. Known causes include earwax buildup, reduced blood flow in the inner ear, neural damage and conditions such as bruxism. Despite its prevalence, there are no standardized drugs or US Food and Drug Administration-approved tinnitus treatments, leaving patients with limited options and variable outcomes.
A growing area of interest is low-level laser therapy (LLLT), also referred to as photobiomodulation. This non-invasive technique uses specific wavelengths of light to stimulate biological processes at the cellular level. A randomized controlled trial conducted by researchers at the Optics and Photonics Research Center (CEPOF) in Brazil compared multiple interventions for idiopathic and refractory tinnitus. Their findings suggest that photobiomodulation, particularly when applied through laser acupuncture and transmeatal stimulation, holds significant promise as a tinnitus treatment.
Understanding tinnitus and its challenges
Tinnitus is among the most widespread auditory symptoms. Epidemiological data suggest that 750 million people worldwide experience tinnitus, with 14% of adults experiencing any tinnitus, and 2% experiencing severe, quality-of-life–limiting symptoms. Risk factors include prolonged noise exposure, age-related hearing loss, head trauma and certain medications.
Why is treatment difficult?
Unlike other auditory disorders, tinnitus does not have a single physiological cause. Instead, it can arise from multiple mechanisms involving the auditory system, nervous system and vascular function. This variability complicates efforts to develop universal treatments. Current options range from ear lavage and pharmacological agents (such as antidepressants and antihistamines) to sound therapy, cognitive behavioral therapy and acupuncture. Results vary widely, with many patients reporting only partial or temporary relief.
Investigating low-level laser therapy for tinnitus
Photobiomodulation is the therapeutic use of low-intensity red or near-infrared light. Unlike ablative surgical lasers, low-level lasers do not generate heat sufficient to damage tissue. Instead, they stimulate mitochondrial cytochrome c oxidase, boosting ATP production. They also enhance microcirculation and oxygenation in targeted tissues and promote anti-inflammatory activity and cellular repair.
These mechanisms make LLLT attractive for addressing inner ear dysfunction and poor peripheral blood flow, both implicated in tinnitus pathophysiology.
To compare the therapies used most frequently for tinnitus, the CEPOF team conducted a randomized, double-blind, controlled trial involving over 100 participants aged 18–65 with idiopathic or refractory tinnitus. Patients were randomly assigned to 10 groups receiving different treatments. Each participant underwent eight treatment sessions over four weeks (twice weekly). Assessments occurred at baseline, post-treatment and two weeks later using the tinnitus handicap inventory questionnaire, which measures the functional, emotional and catastrophic impacts of tinnitus.
The interventions included:
- Laser acupuncture: Application of low-level laser light to traditional acupuncture points, aiming to stimulate neural pathways without needles.
- Transmeatal low-level laser therapy: Direct application of laser light through the ear canal for either 6 or 15 minutes to reach the inner ear structures.
- Vacuum therapy: Use of negative pressure to improve circulation and relieve pressure in the ear.
- Ultrasound therapy: Application of high-frequency sound waves to stimulate tissues and potentially modulate auditory pathways.
- Ginkgo biloba (G. biloba) extract: A herbal supplement derived from the Ginkgo tree, thought to improve microcirculation and antioxidant activity.
- Flunarizine dihydrochloride: A drug that reduces calcium influx in cells, potentially stabilizing neuronal activity related to tinnitus.
- Combination therapies (e.g., laser and vacuum therapy, laser and Ginkgo biloba)
Table 1. Tinnitus patient outcomes from the various treatments tested in the study.
| Treatment | Outcome Summary |
| Laser acupuncture | Significant and lasting improvement |
| Transmeatal LLLT | Improvement, enhanced at 15 minutes |
| LLLT and vacuum therapy | Positive effects, less than LLLT alone |
| LLLT and G. biloba | Lasting therapeutic effect |
| Flunarizine dihydrochloride | Notable improvement in some patients |
| G. biloba alone | Mild improvement |
| Ultrasound therapy | Limited effect |
Key findings and mechanistic insights
The most effective interventions were laser acupuncture and transmeatal low-level laser stimulation, with outcomes improving when irradiation time increased. Combination therapies provided benefits but did not outperform standalone laser interventions.
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“The positive effects include anti-inflammatory action and relaxation. We believe laser therapy can increase peripheral irrigation, which may be the main cause of the problem in many cases, as well as stimulating inner ear cell proliferation and collagen production,” said Vitor Hugo Panhóca, researcher at CEPOF.
The findings highlight several likely mechanisms:
- Enhanced microcirculation: Increased blood flow may alleviate hypoxic stress in cochlear tissues.
- Cellular repair and proliferation: Photobiomodulation supports regeneration of auditory cells.
- Neuroplastic modulation: Laser stimulation may alter aberrant neuronal firing associated with tinnitus perception.
Implications for clinical practice
Despite promising results, variability in treatment parameters has hindered the adoption of LLLT in tinnitus treatment. The CEPOF trial provides critical data on optimal session duration and frequency, offering a foundation for developing clinical protocols.
Tinnitus management often involves a wide spectrum of professionals, including audiologists, ear, nose and throat specialists, dentists and speech therapists. By defining reproducible protocols, photobiomodulation could be integrated into multidisciplinary care, particularly for patients with refractory tinnitus.
Credit: Anthony Camerlo/ Unsplash.
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Key factors for broader adoption include ensuring uniform laser output, wavelength and power density. Educating clinicians in safe and effective application and evaluating sustained efficacy and safety over months or years.
Future directions in tinnitus treatment
While the CEPOF findings reinforce the value of laser-based interventions, further research is essential. Areas of interest for future studies include:
- Long-term efficacy: Assessing whether improvements persist beyond the short-term follow-up period.
- Patient stratification: Determining which subgroups (e.g., vascular vs neural tinnitus) benefit most from LLLT.
- Combination therapies: Exploring synergy between photobiomodulation and behavioral or sound therapies.
- Mechanistic studies: Using imaging and molecular assays to elucidate pathways involved in auditory system repair.
Tinnitus remains a complex and widespread condition without a universal cure. However, advances in low-level laser therapy and photobiomodulation are providing new opportunities for targeted, non-invasive treatment. Clinical evidence indicates that laser acupuncture and transmeatal LLLT are among the most effective current tinnitus treatments, with benefits linked to enhanced blood flow, anti-inflammatory action and cellular repair mechanisms.
By building standardized treatment protocols and expanding mechanistic understanding, photobiomodulation could become a cornerstone of tinnitus management, offering relief to millions affected by this challenging condition.
This article is a rework of a press release issued by the Agência FAPESP. Material has been edited for length and the content has been updated to provide additional context and details of related developments since the original press release was published on our website. This article includes text that has been generated with the assistance of AI. Technology Networks' AI policy can be found here.
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