The Impact of Dietary Factors, BMI, and Physical Activity on Tinnitus: A Scoping Review

1. Introduction

Tinnitus is the subjective perception of sound without an external source [1]. This condition affects a significant portion of adults, and its prevalence increases with age. In Poland, the issue affects approximately 20% of adults and as much as 53% of those over 75 [2]. Moreover, a large-scale study involving 43,064 children in Warsaw revealed a notable underreporting of tinnitus in younger populations [3]. It is estimated that tinnitus occurs in 10–15% of adults in the United States, with around 20% of those suffering from the condition requiring medical intervention [1].

Tinnitus is not a disease, but rather a symptom that often takes a chronic form, significantly impacting a patient’s quality of life by causing sleep disturbances, concentration problems, and chronic levels of psychosomatic stress.

Despite the increasing prevalence of tinnitus and much research, the mechanism of tinnitus is still unclear [4]. Moreover, no unified diagnostic consensus has ever been established. Tinnitus can result from various causes, including hearing damage, neurological disorders, genetic causes [5], noise exposure [6], as well as vascular and somatic factors such as temporomandibular joint dysfunction [1]. Some studies also suggest a potential link between tinnitus and inflammation [7] or the patient’s dietary patterns and nutrient intake. It is also important to take into consideration related symptoms, which might be defined as tinnitus, but it is more consistent with misophonia or hyperacusis [8,9,10].

To date, studies have not provided conclusive evidence for the existence of a therapy that eliminates tinnitus. Modern therapeutic strategies focus mainly on symptom relief and improving the patient’s quality of life. There are many different questionnaires or tools to assess tinnitus [11,12,13]. Such tools have been validated in different languages, allowing large populations to be compared [14,15]. Interest has been given to methods supporting habituation or techniques of managing distress caused by chronic tinnitus. High-level evidence demonstrates the efficacy and safety of Cognitive Behavioral Therapy (CBT) in the management of tinnitus. This conclusion is supported by systematic reviews and corroborated by randomized controlled trials, establishing CBT as the most robustly validated intervention for this condition. Conversely, current research does not provide evidence supporting the efficacy of pharmacological interventions specifically for tinnitus. Moreover, available data indicate a risk of potentially significant adverse effects, thereby limiting the role of drug therapy in routine clinical practice. Tinnitus frequently coexists with hearing impairment, which may influence both symptom perception and treatment strategies. Hearing aids are strongly recommended in cases of concurrent hearing impairment. In addition to facilitating auditory rehabilitation, they should be considered a viable therapeutic option for patients experiencing both tinnitus and hearing loss. Cochlear implantation is reserved exclusively for patients who meet the established candidacy criteria related to the degree of hearing loss.

In addition to behavioral and sound-based approaches, several nutritional and metabolic interventions have been explored as potential strategies for tinnitus management.

The objectives of this study were:

1.

To perform a scoping review of all relevant studies investigating the role of diet, micronutrients, macronutrients, body mass index (BMI), obesity, weight loss, and physical activity in relation to the risk, onset, and severity of tinnitus, as well as their potential contribution to its management.

2.

To include randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies, and to summarize their findings through synthesis presented in narrative analysis.

2. Materials and Methods

This study was conducted as a scoping review and reported according to the PRISMA-ScR guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) [16]. A scoping review methodology was selected due to the heterogeneity of study designs, exposures, and outcome measures across the available literature. A comprehensive structured search was conducted across three major databases: PubMed, Web of Science, and the Cochrane Library. The search was carried out in September 2025 and covered the period from 2005 to 2025. The lower time limit of 2005 was chosen to ensure consistency with contemporary diagnostic criteria for tinnitus and with modern definitions of overweight and obesity, as well as to capture studies conducted after the widespread adoption of standardized instruments such as the Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS). Search terms were organized into four main concepts: tinnitus, diet and nutrition, BMI and obesity and physical activity. The search strategy combined these concepts using Boolean operators: (tinnitus) AND (diet OR nutrition OR antioxidants OR vitamins OR minerals OR macronutrients OR micronutrients OR BMI OR body mass index OR obesity OR weight loss OR weight reduction OR physical activity OR exercise). Exclusion criteria were defined a priori to ensure methodological rigor and consistency. We excluded editorials, letters, and conference abstracts without full data; non-human or in vitro studies; and studies without an available English full text. Articles were also excluded if they did not assess tinnitus as a primary outcome, did not investigate relevant exposures (dietary factors, micronutrients, macronutrients, BMI, obesity, weight loss, or physical activity), or provided insufficient data for extraction. Furthermore, we excluded case reports or case series with fewer than 10 participants due to limited generalizability, as well as studies using non-standardized definitions or outcome measures of tinnitus that precluded meaningful synthesis (e.g., vague self-reported “ringing in ears” without a validated tool).

Based on the keywords, a total of 2107 records were identified. After removing duplicates, 1511 unique records remained. During the title and abstract screening phase, 1372 articles were excluded for not meeting the inclusion criteria. We assessed 78 articles for full-text access, and after applying all exclusion criteria, 21 articles were left for qualitative synthesis. In addition to the primary search results, 3 relevant studies were identified through a review of the reference lists of included articles. Finally, a total of 24 studies were incorporated into the analysis.

We included randomized controlled trials (RCTs), cohort studies, case-control studies, and cross-sectional studies that investigated dietary factors, body mass index (BMI), obesity, weight loss, or physical activity in relation to tinnitus.

Given the heterogeneity of study designs, populations, exposures, and outcome measures, we conducted a qualitative synthesis of the available evidence. Findings were synthesized narratively and organized thematically according to major exposure domains identified in the literature.

3. Results

The characteristics and main findings of all included studies are summarized in Table 1. The results are presented below in a narrative format, organized according to the major exposure domains.

3.1. Impact of Macronutrients on Tinnitus

3.1.1. Protein Intake

In a large-scale, population-based study by Dawes et al. [17], the researchers examined dietary patterns and tinnitus symptoms among a cohort of 34,576 participants. Participants from the UK Biobank were recruited with the aim of being as inclusive as possible of the UK population and were invited via a letter with telephone follow-up. Towards the end of the data collection, the Oxford Web-Q Diet questionnaire (Oxford Web-Q) was included. Oxford Web-Q is a computerized questionnaire on the intake of 200 commonly consumed foods and beverages consumed in the last 24 hours. The tool makes it possible to assess detailed dietary information and analyze macronutrient intake, including protein. Dawes and colleagues found that, after adjusting for demographic, lifestyle, and health-related factors, individuals with a higher protein intake exhibited a reduced risk of experiencing tinnitus (odds ratio of 0.90; 95% CI; p < 0.05).

The effect of protein intake was also analyzed by Jarach et al. [18] in a hospital-based case-control study. The study consisted of 185 patients diagnosed with idiopathic tinnitus and control group consisted of 198 patients without a tinnitus diagnosis enrolled in the surgery departments of the San Gerardo Hospital. Dietary habits and diet information were assessed through a 37-item food frequency questionnaire, which allowed the number of portions per week of foods in 5 categories to be recorded: cereals, protein-rich foods, fat-rich foods, vegetables, and fruits. The category of protein-rich foods consisted of red meat, poultry, legumes, fish, eggs, sausages, liver, ham, and prosciutto. For each item, patients were asked about their consumption in the previous year. The study found a statistically significant inverse association between the consumption of protein-rich foods and the onset of tinnitus symptoms. Consuming three or more portions (one portion defined as 150 g) of poultry per week was associated with a reduced risk of tinnitus onset. Specifically, compared to individuals who reported eating zero or one portion per week, those consuming three or more portions had an odds ratio of 0.43 (95% CI, 0.23–0.81, p for trend = 0.009). Similarly, consuming at least two portions of prosciutto per week (one portion defined as 50 g) and two portions of legumes per week (one portion defined as 100 g) was also associated with a protective outcome. For prosciutto, the OR for individuals consuming at least two portions per week was 0.44 (95% CI, 0.23–0.85, p for trend = 0.019) compared to those who rarely or never consumed it. For legumes, the OR for those consuming at least two portions per week was 0.50 (95% CI, 0.28–0.92, p for trend = 0.023) compared to those with occasional or no consumption.

3.1.2. Fat Intake and Cholesterol Levels

A large-scale cross-sectional study conducted by Lee HJ et al. [19] investigated the association between serum lipid levels and tinnitus risk in a representative sample of Korean older adults. The study analyzed data from 6,021 participants aged 60 years or older, collected from the 2016–2018 Korea National Health and Nutrition Examination Survey (KNHANES). KNHANES is an ongoing nationwide survey that uses stratified, clustered sampling to include participants representing the entire Korean population. Participants underwent standardized health interviews assessing tinnitus prevalence and severity, categorized as “not annoying,” “irritating,” or “severely annoying and causing sleep problems.” Serum lipid levels, including total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were measured, and hypertriglyceridemia was defined as a serum triglyceride level of ≥200 mg/dL. A high TC/HDL-C ratio was defined as greater than 5.0, indicating elevated cardiovascular risk. After adjusting for various factors, including age, sex, hypertension, diabetes, dyslipidemia, smoking status, obesity, noise exposure, and psychological factors, multivariable logistic regression analysis revealed significant associations between serum lipid levels and tinnitus. Participants with hypertriglyceridemia had a 1.27-times higher odds ratio (OR) of experiencing tinnitus compared to those without hypertriglyceridemia (95% CI 1.04–1.56, p = 0.022). Similarly, a high TC/HDL-C ratio was associated with a 1.21-times higher OR of tinnitus (95% CI 1.02–1.44, p = 0.025). When the severity of tinnitus was analyzed, participants with hypertriglyceridemia and a high TC/HDL-C ratio showed significantly higher odds of reporting “severely annoying” tinnitus compared to those with normal lipid levels.

Further exploring this relationship, a study by Sutbas et al. [20] investigated the potential role of a low-cholesterol diet and antihyperlipidemic therapy in reducing tinnitus severity in patients with hyperlipidemia. The study was based on 42 male patients aged 19–60 years presenting with elevated cholesterol levels or triglyceride or both. Each patient was required to complete a tinnitus handicap questionnaire in each interview, and to rate their tinnitus from 1 to 10 (with 10 being loudest). Before any intervention, assessment was made with a complete blood count containing glucose level from a fasting blood sample; plasma cholesterol; high-density lipoprotein (HDL); low-density lipoprotein (LDL); very low-density lipoprotein (VLDL), and triglyceride levels. All 42 patients were placed on a low-cholesterol diet or antihyperlipidemic therapy with simvastatin or atorvastatin used daily for up to 2 years (minimum 12.4 months). After that, patients were divided into two groups: the “responsive” group, consisting of 20 patients who presented lower cholesterol or triglyceride levels after the treatment, and the “unresponsive” group, made up of 22 patients who had no response to either diet or pharmacotherapy and still presented hyperlipidemia. The main criteria for being qualified as a “responsive” patient were defined as a return to normal cholesterol or triglyceride levels or a minimal drop of 40% from the initial level of each value. In the responsive group (n = 20), tinnitus scores ranged from 2 to 9 before therapy (mean = 4.95, SD = 1.9) and decreased to a range of 1 to 8 after therapy (mean = 3.45, SD = 2.6; p < 0.05). The reduction in tinnitus scores before and after therapy in this group was statistically significant. For patients in the unresponsive group (n = 22), tinnitus scores ranged between 2 and 9 (mean, 5.36; SD, 2.3) after therapy. In the responsive group (n = 20), 7 patients rated their symptoms as staying the same (35%), 2 rated it as increased (10%), 7 as decreased (35%), and 4 had no tinnitus at all (20%). In comparison, in the unresponsive group (n = 22), 10 patients rated their tinnitus as staying the same (47%), 9 as increased (42%), 2 as decreased (9%), and 1 reported no tinnitus symptoms.

3.2. Impact of Micronutrients on Tinnitus

3.2.1. Vitamin B2, B3 and B12

The potential impact of vitamins B2 and B3 on tinnitus symptoms has been analyzed by Lee DY et al. [21]. The study was based on an analysis of data from the sixth Korea National Health and Nutrition Examination Survey. After implementing exclusion criteria, 7,621 subjects were enrolled, 1,435 (18.9%) suffering from tinnitus symptoms and 6,186 (81.1%) without. The dietary intake of 112 commonly consumed foods was assessed using a food-frequency questionnaire. Multivariate analysis of nutritional substances showed that, for all age groups, only lower vitamin B2 intake was independently associated with a higher prevalence of tinnitus (OR, 1.253; 95% CI 1.049–1.496; p = 0.013). In more detail, in the age groups 51–55 and 56–60 years, vitamin B2 intake was significantly lower in those with tinnitus than without (p<0.001 for ages 51–55 and p = 0.013 for ages 56–60). In terms of vitamin B3, analysis highlighted that, across all age groups, lower intake of this vitamin was correlated with reports of higher tinnitus-related annoyance, with the correlation reaching statistical significance in the 66–70 and 76–80 age groups (p = 0.002 and p = 0.029).

Two clinical studies have specifically examined the association between vitamin B12 status and tinnitus, focusing on both the prevalence of deficiency among patients and the effects of supplementation. A case-control study by Berkiten et al. [22] assessed 100 patients with non-pulsatile tinnitus and 20 healthy controls. Serum vitamin B12 levels were measured, and patients with concentrations <180 pg/mL were classified as deficient. Among tinnitus patients, 63% were vitamin B12-deficient, compared to 60% of controls, a difference that was not statistically significant (p = 0.80, OR = 1.13). A total of 63 tinnitus patients with vitamin B12 deficiency underwent parenteral B12 replacement (intramuscular injections daily for 5 days, then monthly for one year). On the tinnitus visual analogue scale (VAS), the mean score decreased only minimally (6.40 ± 1.58 to 6.24 ± 3.05), with 8 patients reporting subjective relief, but the overall change was not significant (p > 0.05). A study by Singh C et al. [23], randomized, placebo-controlled trial enrolled 40 patients with chronic tinnitus, of whom 42.5% were vitamin B12-deficient. Participants were randomized to receive intramuscular methylcobalamin (1,500 µg weekly for 6 weeks) or placebo. Among deficient patients in the treatment group, tinnitus severity improved significantly, with TSI scores decreasing from 36.5 ± 8.2 to 28.2 ± 7.5 (p<0.05) and VAS loudness from 6.5 ± 1.2 to 4.8 ± 1.1 (p<0.05). No improvements were observed in non-deficient patients or in the placebo arm.

3.2.2. Vitamin D3

The potential role of vitamin D deficiency in tinnitus has been increasingly explored in both clinical and population-based settings. In a case-control study conducted by Nowaczewska et al. [24], 201 patients with chronic subjective tinnitus and 99 healthy controls were examined for serum 25-hydroxyvitamin D [25(OH)D] concentrations. The mean vitamin D level was significantly lower in tinnitus patients compared with controls (19.86 ± 10.5 ng/mL vs. 27.43 ± 12.5 ng/mL; p<0.0001). Vitamin D deficiency (<20 ng/mL) was present in 50.7% of tinnitus patients versus 22.2% of controls (p<0.0001). Within the tinnitus group, lower vitamin D levels were associated with greater symptom burden: individuals with severe deficiency (≤15 ng/mL) had significantly higher THI scores (41.6 ± 20.1 vs. 32.4 ± 18.9; p<0.05) and higher VAS loudness ratings (6.4 ± 1.5 vs. 5.3 ± 1.7; p<0.05) compared with patients whose vitamin D exceeded 15 ng/mL. These clinical observations were further supported by Aliyeva et al. [25], who analyzed a large nationally representative cohort of the Korean National Health and Nutrition Examination Survey including 16,408 adults aged 20 years and older. Vitamin D status was assessed by serum 25(OH)D concentration and categorized into quartiles. After adjusting for demographic and lifestyle factors, participants in the lowest quartile of vitamin D had a significantly higher prevalence of tinnitus compared with those in the highest quartile (adjusted OR = 1.24; 95% CI: 1.05–1.46; p=0.012).

3.2.3. Antioxidants and Multivitamin Supplements

Three studies – Petridou et al. [26], Savastano et al. [27] and Polanski et al. [28] – have analyzed the potential effects of antioxidant supplements as a therapy for tinnitus. Petridou et al. [26] conducted a double-blind, placebo-controlled clinical trial to evaluate whether taking antioxidant supplements ameliorated tinnitus symptoms. There were 70 patients who met the criteria and half of them were randomized to the antioxidant group. The antioxidant group was instructed to take one multivitamin-multimineral tablet daily and one tablet of alpha-lipoic acid (300 mg alpha-lipoic acid per tablet) twice daily, while the placebo group took three placebo tablets at corresponding times. The multivitamin-multimineral tablet consisted of key vitamins and minerals in specific doses (vitamin A, 781 µg; vitamin C, 150 mg; vitamin D3, 10 µg; vitamin E, 100 mg; and vitamin B complex [B1, B2, B3, B6, and B12]). The minerals included zinc (15 mg), selenium (100 µg), iron (14 mg), and magnesium (50 mg). The intervention lasted 3 months, and throughout this time participants were advised to maintain their existing medical treatments, dietary habits, and exercise routines. After the 3 months of intervention, the sample consisted of 63 patients – 29 in the placebo group and 34 in the antioxidant group. Following the three-month intervention, the antioxidant group demonstrated a statistically significant reduction in tinnitus loudness and minimum masking level (MML) when compared with baseline, whereas the placebo group showed no significant improvement. In the antioxidant group, the mean tinnitus loudness decreased from 45.0 dB (SD = 15.3) to 30.8 dB (SD = 11.2), representing a mean change of –14.2 dB (SD = 12.7; p < 0.001). In contrast, the placebo group experienced a non-significant change, with mean tinnitus loudness decreasing from 47.1 dB (SD = 20.5) to 40.4 dB (SD = 15.5), yielding a mean change of –6.7 dB (SD = 8.8; p = 0.168). Questionnaire analysis further indicated beneficial effects of antioxidant supplementation, with reductions in THI, VAS, and overall tinnitus-related functioning, while the placebo group showed no comparable improvements. Analysis for interactions confirmed that the antioxidant group’s outcomes were significantly different from those of the placebo group, particularly with respect to THI. In the antioxidant group, the THI score decreased significantly from a mean of 31.6 (SD = 19.3) at baseline to 25.5 (SD = 18.0) at follow-up, reflecting a mean reduction of –6.1 points. In contrast, the placebo group showed a slight, non-significant increase from 40.6 (SD = 27.7) to 42.8 (SD = 24.5), with a mean change of +2.2 points.

The study by Savastano et al. [27] was based on 31 patients diagnosed with unilateral idiopathic tinnitus who were administered 6 weeks of antioxidant therapy (three courses of 2 weeks each with 2 weeks between courses). The treatment involved daily doses of glycerophosphorylcholine (55 mg), glycerophosphorylethanolamine (45 mg), beta-carotene (12 mg), vitamin C (180 mg), and vitamin E (10 mg). The study assessed several factors, including levels of reactive oxygen species (ROS) and tinnitus severity, both 48 hours before and within 48 hours following the end of treatment. Oxidative stress was evaluated using the markers malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE), measured in blood drawn directly from the jugular vein, based on previous evidence suggesting that oxidative stress may be detectable in cerebral veins in tinnitus patients [29]. After treatment, both MDA and 4-HNE levels decreased significantly. Mean plasma MDA levels decreased from 2.10 to 1.98 µmol/dL (p = 0.003), while 4-HNE levels dropped from 2.36 to 2.16 µmol/dL (p = 0.002). Clinical improvement was also observed, as tinnitus loudness significantly decreased from a mean of 23.6 dB to 16.7 dB (p = 0.002), and subjective disturbance measured by the VAS was reduced from 58.0 to 35.7 (p = 0.001). No significant differences in clinical outcomes were found between male and female patients (p > 0.05).

However, not all trials have yielded favorable outcomes, and some investigations have failed to demonstrate any therapeutic benefit of antioxidant supplementation for tinnitus. A prospective, randomized, double-blind, placebo-controlled clinical trial was conducted by Polanski et al. [28] in 58 elderly patients (≥60 years) with chronic tinnitus associated with sensorineural hearing loss. Participants were randomized into four groups receiving either Ginkgo biloba dry extract (120 mg/day), a combination of α-lipoic acid (60 mg/day) with vitamin C (600 mg/day), papaverine hydrochloride (100 mg/day) with vitamin E (400 mg/day), or placebo. The intervention period lasted six months, and tinnitus outcomes were assessed at baseline and at the end of treatment using the Tinnitus Handicap Inventory, which was analyzed both as a categorical severity grade and as a continuous score. Across all treatment groups, no statistically significant improvements were observed when comparing pre- and post-intervention values. The distribution of THI severity grades remained unchanged (p = 0.441), and mean THI scores showed no significant reduction either within groups or between groups (p = 0.848). Subgroup analyses likewise failed to identify any treatment-related benefit.

3.2.4. Minerals

Study conducted by Tang et al. [30] highlighted the potential effect of intake of specific vitamins and minerals, notably zinc and iron, and the risk of developing tinnitus over a 10-year period. A total of 2,947 adults aged 49 years or older participated in the study. After an initial assessment of tinnitus symptoms and dietary intake, participants were monitored over 5- and 10-year follow-ups. At the 10-year follow-up, results showed a significant association between lower intakes of zinc and iron and increased risks of tinnitus. Individuals in the lowest quintile of dietary iron intake (≤9.51 mg/day) had a 35% greater risk of developing tinnitus compared to those with higher intakes. For zinc, individuals consuming ≤8.48 mg/day faced a 44% higher risk of tinnitus incidence over the study period. Study conducted by Person et al. [31] evaluated the effect of zinc supplementation in tinnitus patients. The review included three randomized controlled trials with a total of 209 participants. Across these trials, oral zinc administration did not produce statistically significant improvements in tinnitus outcomes compared with placebo. No consistent changes were observed in tinnitus loudness, severity, or disability scores, and the pooled analysis showed no therapeutic benefit.

3.3. Impact of BMI and Weight Loss on Tinnitus

The study conducted by Gallus et al. [32] provided nationally representative data on tinnitus prevalence and associated risk factors based on interviews with 2,952 adults. Anthropometric measurements were recorded, and BMI was categorized into normal weight, overweight, and obese. The results showed that obesity (BMI ≥30 kg/m²) was significantly associated with a higher likelihood of reporting tinnitus, particularly among participants aged 45 years and older. In multivariable logistic regression, obese individuals had more than twofold higher odds of tinnitus compared with those of normal weight, while overweight participants showed only a weaker, borderline association. When the analysis was restricted to chronic tinnitus (≥3 months), the association became even stronger.

A hospital-based case-control study by Martines et al. [33] also supported the link between metabolic risk factors and tinnitus. The study included 46 patients with chronic tinnitus and 74 age- and sex-matched controls without tinnitus. Data collection involved medical history, anthropometric measures, audiometric evaluation, and laboratory blood tests. The results demonstrated that obesity and large neck circumference were significantly more common in the tinnitus group than in controls. Importantly, the coexistence of obesity and hypertension markedly increased the odds of having tinnitus.

Similar findings were reported by Torun et al. [34] in a case-control study specifically evaluating the association between BMI and tinnitus. The study included 100 patients with chronic subjective tinnitus and 113 healthy controls matched for age and sex. The analysis revealed that mean BMI was significantly higher in tinnitus patients, and the prevalence of overweight and obesity was also greater among tinnitus patients than in controls. Since no significant differences in age or sex distribution were observed between groups, the authors suggested that the association was specifically linked to BMI.

Complementary evidence comes from a hospital-based observational study by Sogebi et al. [35], which characterized tinnitus and associated factors in adult patients attending a specialist otolaryngology clinic between 2007 and 2011. Detailed questionnaires and anthropometric measures were collected from all participants. Among patients reporting tinnitus, 21.5% were classified as obese (BMI >30 kg/m²), whereas only 6.3% of the control group fell into this category (p = 0.024).

More detailed insight into body composition was provided by Han et al. [36]. The study included 2,257 adults, of whom 204 reported tinnitus and 2,125 served as non-tinnitus controls. In men, tinnitus was associated with higher total body fat percentage, greater trunk and leg fat percentage, and larger waist circumference. Men with tinnitus also had lower total body fluid and intracellular fluid percentages. In contrast, differences among women were much less pronounced and lost significance after adjustment. When obesity was defined using total body fat percentage or waist circumference, tinnitus prevalence was significantly higher in obese men, suggesting that the association may be particularly relevant for central adiposity and male body composition patterns.

In addition to body mass and body composition, attention has also been directed toward physical activity as a potentially modifiable factor influencing tinnitus. This association was reinforced by a large cross-sectional study conducted by Chalimourdas et al. [37], which included 2,751 adults with chronic tinnitus. Using the International Physical Activity Questionnaire (IPAQ), the investigators showed that higher levels of moderate-intensity activity were associated with lower tinnitus loudness, whereas more vigorous activity was associated with both lower loudness and lower severity. Similar conclusions were drawn by Chen et al. [38] in an analysis of 3,826 adults from the U.S. National Health and Nutrition Examination Survey. Individuals engaging in any form of physical activity had a lower prevalence of tinnitus than inactive participants, and subgroup analyses indicated that moderate weekly activity was associated with significantly reduced odds of tinnitus. Dose–response modelling further suggested that moderate amounts of physical activity may provide the greatest protective effect.

Building on these observational associations, interventional trials have further examined whether structured weight-loss programs based on physical activity and diet can directly influence tinnitus outcomes. A study by Özbey-Yücel et al. [39] aimed to assess the effects of a structured weight-loss intervention program involving diet and physical activity (PA) on the severity of tinnitus and overall quality of life. The randomized controlled trial recruited 46 obese individuals (BMI ≥ 30 kg/m²) aged between 20 and 65 years who had experienced tinnitus for at least 6 months. Participants were randomly assigned to one of three groups: diet and physical activity (PA) (n = 13), diet only (n = 16), and a control group with no changes in lifestyle (n = 17). Each intervention group followed a 12-week program consisting of diet only or diet and physical activity. Diet plans were personalized and prepared by registered dieticians for each participant. The target macronutrient distribution was 45–60% carbohydrates, 10–20% proteins, and 25–30% fats. Patients in the diet + PA group were asked to take at least 10,000 steps daily, with step counts tracked using a pedometer. Before and after the intervention, all participants completed tinnitus severity assessments based on the Tinnitus Handicap Inventory and Visual Analogue Scale, alongside quality-of-life measures using the Short Form Health Survey (SF-36) [40]. After the 12-week program, participants in both groups experienced significant reductions in body weight. The diet + PA group achieved a mean weight loss of 6.5 ± 2.6 kg and a BMI reduction of 2.1 ± 1.1 kg/m² (p < 0.01), while the diet group showed a mean weight loss of 4.1 ± 1.0 kg and a BMI reduction of 1.5 ± 0.3 kg/m² (p < 0.05). In contrast, the control group exhibited negligible changes (0.3 ± 0.5 kg in weight; 0.1 ± 0.1 kg/m² in BMI).

Following intervention, both the diet and diet + PA groups exhibited improvements in tinnitus-related outcomes and overall quality of life compared to the control group. The THI scores decreased by –15.0 ± 9.5 points in the diet + PA group and –14.0 ± 10.0 in the diet group, versus –7.0 ± 5.0 in the control group (p = 0.003). VAS scores also declined more substantially in the intervention groups (–3.0 ± 1.5 in diet + PA; –2.0 ± 1.0 in diet) than in controls (–0.5 ± 0.5; p < 0.01). Similarly, SF-36 scores improved by +10.0 ± 5.5 in the diet + PA group and +6.0 ± 2.7 in the diet group, compared to +3.0 ± 2.0 in controls (p = 0.001). The greatest improvement in SF-36 scores was seen in the diet + PA group, exceeding the gains in other groups, suggesting that adding physical activity to the intervention strategy yields additional benefits beyond weight loss, particularly in enhancing patients quality of life.

A more recent study by the same research group (Özbey-Yücel et al.) expanded upon their earlier research by increasing the sample size to 63 participants and introducing a new intervention group focused on physical activity [41]. The participants were again obese individuals (BMI ≥ 30 kg/m²) aged between 20 and 65 years who had been experiencing tinnitus for at least 6 months. The study followed a similar randomized controlled design but incorporated an additional physical activity-only group, resulting in four distinct groups: diet + physical activity (n = 15), diet only (n = 16), physical activity only (n = 15), and a control group (n = 17). By the end of the 12-week program, body weight significantly decreased in the diet + PA group (−5.9 ± 3.5 kg, p < 0.01), diet-only group (−3.4 ± 0.9 kg, p < 0.01), and PA-only group (−2.0 ± 2.1 kg, p < 0.05), while the control group showed no significant change (+0.3 ± 0.6 kg). Changes in tinnitus severity and frequency were consistent with weight loss, with THI scores decreasing by −13.3 ± 2.6 units in the diet + PA group, −9.1 ± 4.5 units in the diet group, and −8.6 ± 3.8 units in the PA group (p < 0.05). Notably, the VAS severity and annoyance scores also showed significant reductions in all intervention groups, with the diet + PA group experiencing the greatest improvements (−2.5 ± 1.1 for severity, −2.7 ± 1.0 for annoyance). An important observation was the relationship between percentage weight loss and tinnitus improvement. Participants who lost at least 5% of their initial body weight exhibited a more significant reduction in tinnitus severity (−14.0 ± 13.0 dB, p < 0.05) and VAS scores (−2.0 ± 1.1 for severity, −2.5 ± 1.8 for annoyance) compared to those with less than 5% weight loss.

These findings were recently corroborated in a different clinical setting focusing on older adults with metabolic syndrome. In a recent randomized controlled trial, Ismail et al. [42] investigated the effects of a 12-week lifestyle-modification program combining dietary restriction with supervised treadmill exercise in 60 older adults (≥65 years) with metabolic syndrome and chronic subjective tinnitus. Participants were randomly allocated either to the intervention group (n = 30) or to a wait-list control group (n = 30). Post-intervention, the lifestyle group showed significant within-group reductions in BMI (32.91 ± 2.23 → 30.76 ± 2.03 kg/m²; p<0.001) and waist circumference (110.16 ± 12.98 → 102.26 ± 14.46 cm; p<0.001). Tinnitus outcomes improved in the lifestyle group with reductions in VAS severity (6.90 ± 1.38 → 4.74 ± 1.28; p<0.001), VAS discomfort (6.98 ± 1.39 → 4.08 ± 1.06; p<0.001), and THI (49.26 ± 9.93 → 33.66 ± 9.09; p<0.001), all superior to controls (between-group p<0.001 for VAS severity, VAS discomfort, and THI; control post-values: VAS severity 7.38 ± 1.49, VAS discomfort 7.43 ± 1.16, THI 53.06 ± 9.62).

4. Discussion

This scoping review mapped a heterogeneous body of literature examining associations between diet, nutritional status, metabolic health, and tinnitus. The available evidence suggests several recurring patterns, particularly regarding metabolic disturbances, selected micronutrients, and obesity-related factors; however, the literature remains methodologically diverse and is dominated by observational designs.

Both protein and fat intake emerged as important factors in tinnitus development and severity, showing the importance of dietary macronutrients in auditory health. Both population-based and clinical studies suggest that high protein intake may be associated with reduced risk of tinnitus development and severity [17,18], but the evidence from interventional studies is highly limited. Protein is thought to play a role in cochlear health by supporting tissue repair and immunity, reducing potential damage within auditory pathways. This hypothesis aligns with the suggestion that adequate protein intake might counteract some of the degenerative processes associated with tinnitus, although further research is needed.

Fats, often linked with elevated cholesterol levels, have previously been associated with poorer hearing outcomes [43]. The pathological mechanism behind these hearing losses remains unclear. Some studies suggest that elevated blood viscosity and atherosclerotic alterations in cochlear vessels, which reduce blood flow to the cochlea, may lead to hearing impairment [44,45,46]. Interventions targeting cholesterol levels, such as low-cholesterol diets and antihyperlipidemic therapy, has shown promising results in reducing the risk of tinnitus development and reducing the severity of symptoms [20]. Such interventions may also enhance overall hearing quality, as demonstrated by Rosen et al. [47] who observed improved hearing thresholds in individuals following a low-fat diet. Their study highlighted the link between vascular health and auditory function, suggesting that dietary changes positively impact cochlear health alongside cardiovascular benefits. Findings by Lee HJ et al. [19] further reinforce this connection by showing an association between dyslipidemia and tinnitus risk in older adults. Their large-scale cross-sectional analysis demonstrated that individuals with hypertriglyceridemia and elevated total cholesterol/HDL ratios were significantly more likely to experience tinnitus. Beyond auditory outcomes, metabolic dysregulation of lipids may also affect the psychological burden associated with tinnitus. Recent findings by Boecking et al. [48] suggest that altered lipid profiles may be linked with greater depressive symptoms in patients with chronic tinnitus, highlighting the potential interaction between metabolic health and emotional distress. Given that tinnitus severity is often modulated by psychological factors, these observations underscore the importance of considering both metabolic and psychosocial dimensions in tinnitus management.

While macronutrient intake and metabolic health may influence tinnitus outcomes through vascular and metabolic pathways, increasing attention has also been directed toward the potential role of micronutrients. Micronutrients are integral to various physiological processes and may play a significant role in auditory health. Reviewed studies showcased the potential positive impact of certain nutritional factors – vitamins, antioxidants, and minerals – on tinnitus prevalence and severity. Vitamin B2 (riboflavin), B3 (niacin) and B12 (cobalamin) are part of the B-complex group, each contributing to cellular energy production and nerve function and both are crucial for maintaining auditory health. Vitamin B2 may play a protective role against tinnitus by enhancing mitochondrial energy production via oxidation-reduction reactions. Its potential to counteract oxidative stress is particularly relevant, as oxidative damage is a potential mechanism in the pathophysiology of tinnitus [49]. Historically, vitamin B3 (nicotinic acid) has already been utilized in the management of tinnitus [50]. While the precise mechanism underlying its effects remains uncertain, it is hypothesized that the vasodilatory properties of vitamin B3 may help reduce tinnitus. For vitamins B2 and B3, results from the KNHANES survey by Lee DY et al. [21] demonstrated that lower intake was consistently linked with a higher prevalence of tinnitus and greater symptom annoyance. Although the observed effect size was modest (OR ≈ 1.25 for B2 deficiency), the robustness across multiple age groups suggests a contributory role of these vitamins in maintaining auditory health. In contrast, evidence on vitamin B12 remains less consistent. Berkiten et al. [22] reported high rates of deficiency among tinnitus patients but without significant differences compared to controls, suggesting that deficiency may be common in the general population. Interventional evidence remains limited, however, a randomized controlled trial by Singh et al. [23] demonstrated that vitamin B12 supplementation was associated with reductions in tinnitus severity among patients with confirmed deficiency. These findings suggest that while micronutrient deficiencies may contribute to tinnitus risk in certain populations, the potential therapeutic benefit of supplementation likely depends on baseline nutritional status.

Among individual micronutrients, vitamin D has also been investigated in relation to tinnitus. Evidence from both clinical and population-based studies suggests that vitamin D deficiency may be associated with increased tinnitus prevalence and symptom severity. In a case–control study, Nowaczewska et al. [24] reported significantly lower serum 25(OH)D levels in patients with chronic tinnitus compared with controls, with deficiency associated with higher THI and VAS scores. Similar trends were observed in analyses based on the Korea National Health and Nutrition Examination Survey, where individuals in the lowest vitamin D quartile showed higher odds of reporting tinnitus than those with higher vitamin D levels [25].

In addition to vitamins, antioxidant compounds have also been explored as potential therapeutic agents for tinnitus. However, the available evidence remains heterogeneous, reflecting the wide variety of compounds tested and differences in study design and patient populations. Some clinical studies have reported improvements in tinnitus-related outcomes following antioxidant supplementation. For example, Petridou et al. [26] observed reductions in tinnitus loudness and improvements in patient-reported outcomes following treatment with a multivitamin–multimineral preparation combined with α-lipoic acid. Similarly, Savastano et al. [27] reported decreases in oxidative stress markers accompanied by reductions in tinnitus loudness and subjective annoyance after antioxidant therapy. These findings support the hypothesis that oxidative stress may contribute to tinnitus pathophysiology and that antioxidant strategies could potentially mitigate some of these effects. Nevertheless, not all studies have demonstrated beneficial outcomes. In a randomized, double-blind, placebo-controlled trial, Polanski et al. [28] evaluated several antioxidant regimens, including Ginkgo biloba, α-lipoic acid with vitamin C, and papaverine with vitamin E, and found no significant improvements in tinnitus severity compared with placebo. Such discrepancies may reflect differences in the composition and dosage of antioxidant formulations, treatment duration, and baseline characteristics of the study populations. Overall, although antioxidant therapy is biologically plausible through its potential to reduce oxidative stress, current evidence remains inconsistent and insufficient to support its routine use in tinnitus management.

Beyond vitamins and antioxidants, several studies have examined the potential role of trace elements, particularly zinc and iron, in tinnitus development. These micronutrients are involved in key physiological processes relevant to auditory function. Iron plays a central role in oxygen transport and cellular energy metabolism, while zinc contributes to cochlear physiology and synaptic activity within auditory pathways [51].

Observational evidence suggests that deficiencies in these minerals may be associated with increased tinnitus risk. In a 10-year prospective cohort study, Tang et al. [30] reported that lower dietary intake of zinc and iron was associated with a higher incidence of tinnitus. Such findings support the hypothesis that adequate mineral intake may contribute to maintaining auditory system function. However, interventional evidence has not consistently demonstrated therapeutic benefits. A systematic review by Person et al. [31] found that zinc supplementation did not significantly improve tinnitus loudness, severity, or disability compared with placebo. These findings suggest that although low intake of certain trace elements may be associated with tinnitus risk, current clinical evidence does not support routine mineral supplementation as an effective treatment strategy.

Body Mass Index (BMI) is closely linked to diet, since diet and nutrient intake play a key role in determining body weight. Across diverse study designs and populations, obesity consistently emerged as a significant risk factor for tinnitus. Large-scale surveys and hospital-based studies alike have shown that individuals with elevated BMI are more likely to report both incident and chronic tinnitus compared with their normal-weight counterparts [32,33,34,35]. These associations appear robust, with several investigations also highlighting the amplifying role of comorbid conditions such as hypertension [33]. More recent analyses that considered body composition have further refined this picture, suggesting that central adiposity and altered fat distribution, rather than overall weight alone, may be particularly relevant [36]. Collectively, these findings indicate a potential association between obesity, metabolic disturbances, and tinnitus risk, underscoring the need to view tinnitus not only as an isolated auditory disorder but also as a condition closely tied to systemic health.

Beyond risk, interventional evidence suggests that weight reduction may also influence tinnitus severity. Randomized trials by Özbey-Yücel et al. [39,41] demonstrated that lifestyle programs incorporating dietary modification and physical activity were associated with improvements in tinnitus severity and quality-of-life measures. Similar findings were reported by Ismail et al. [42], who observed reductions in BMI and waist circumference alongside improvements in tinnitus-related outcomes following a structured lifestyle intervention in older adults with metabolic syndrome.

Taken together, observational and clinical evidence suggest that obesity might be both a risk factor and a modifiable therapeutic target in tinnitus. While the observational studies are limited by potential confounding, the convergence of results across settings and the replication of symptom improvements in randomized interventional studies indicate that weight reduction may be associated with improvements in tinnitus severity and quality of life.

4.1. Limitations

The studies included in this review provide valuable insight into the role of dietary factors and BMI in the development and management of tinnitus. However, to properly frame the findings and highlight areas for future research, several limitations need to be acknowledged. First, some studies were conducted in specific populations, which may limit generalizability. For example, several analyses relied on data from the Korea National Health and Nutrition Examination Survey (KNHANES) [21,23,27], which, while robust, is limited to a specific geographic and ethnic population. Similarly, the study by Jarach et al. [20] focused only on patients in a hospital setting, which introduces potential selection bias since these patients might not represent the general population. Second, many studies relied on self-reported dietary assessments [20,28], which are commonly used in large epidemiological studies but may introduce recall and reporting bias. In addition, most of the available evidence derives from cross-sectional or observational studies, which limits the ability to determine causal relationships and raises the possibility of residual confounding or reverse causality. Longitudinal evidence remains limited, although a few studies have attempted to address this through longer follow-up periods [32]. Finally, as a scoping review, this study aimed to map the available evidence rather than to quantitatively synthesize effect sizes. The included studies were heterogeneous with respect to design, populations, exposures, and outcome measures, which precluded a formal meta-analysis. Nevertheless, by summarizing the current literature on diet, micronutrients, BMI, and physical activity in relation to tinnitus, this review provides an overview of existing research and identifies important gaps for future investigation.

4.2. Future Research

Future research should address the current predominance of observational evidence by conducting large, well-designed randomized controlled trials to test whether dietary modification, weight reduction, and physical activity can reduce tinnitus severity. Standardization of outcome measures, including both validated questionnaires and objective audiological tests, is essential to enable synthesis across studies. More diverse populations should be included, as most existing evidence comes from restricted geographic or clinical settings.

5. Conclusions

The available literature suggests potential associations between dietary factors, micronutrient status, obesity, and physical activity with tinnitus risk and symptom severity. Although the evidence is heterogeneous and largely based on observational studies, several reports indicate that metabolic health and lifestyle behaviors may influence tinnitus-related outcomes. Interventional evidence further suggests that lifestyle-based approaches, including dietary modification and increased physical activity, may contribute to improvements in symptom burden and quality of life. However, the current evidence base remains constrained by methodological variability, potential confounding, and reliance on self-reported dietary assessments. Further well-designed prospective studies and randomized controlled trials are required to clarify these relationships and determine the potential role of lifestyle interventions in tinnitus management. Nonetheless, the findings highlight the relevance of metabolic and lifestyle-related factors as emerging areas of interest in tinnitus research and clinical care.