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Yet the consequences are unknown Bioavailability: there are four specific metabolic steps necessary to convert cyanocobalamin into one of the coenzyme forms, which is a clear metabolic disadvantage (3) Utilisation problems: certain hereditary diseases, as well as metabolic disorders, prevent the conversion of cyanocoalamin into the active B12 forms (4) Steals methyl groups: cyanocobalamin requires a methyl group to convert into methylcobalamin, which it takes from the important amino acid S-adenosylmethionine (SAM)

21 On the other hand, a study that followed 4,746 individuals with tinnitus for four years found 18.3% of cases resolved, 9% improved, 9% worsened, and about 64% experienced no change, 22 and a study in which a questionnaire was administered to 528 tinnitus patients found 25% reported the severity of their tinnitus had increased since its onset

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J Clin Neurosci