I am on several medications for arthritis and have now developed tinnitus. If there's a connection, is there a cure?

G.G.

First, let's assume that your tinnitus is related to one or more of your medications. I hope this is the case, because if it is, the cure is dead simple: you need to get off the offending medication. Aspirin-based medications (salicylates) are well-known causes of tinnitus, especially when used at high doses, and such medications are often used in the treatment of rheumatoid arthritis. Quinine is another well-known cause of tinnitus. Quinine is usually prescribed for muscle cramps. Hundreds of other drugs have been associated with tinnitus. Also, you need to know that alcohol, caffeine and nicotine each can cause a subjective worsening of your tinnitus.

If you are taking neither salicylates nor quinine, then your doctor will need to take your medication list and review it, using his trusty PDR (Physician's Desk Reference, a huge book updated annually that contains extensive information on every prescription drug). If there are still no obvious culprits, then it may be worthwhile eliminating drugs, one by one, to see whether this makes a difference. In other words, let's say you take drugs A, B and C. During the first week, you would stop taking A but continue taking B and C. During the second week, you would eliminate B, but continue taking A and C, and so forth. You would pay close attention to your tinnitus during this trial. Keeping a daily symptom diary would be extremely helpful. Needless to say, you must do such an elimination trial ONLY under your doctor's guidance.

You ought to consider the possibility that your tinnitus is unrelated to your medications. Tinnitus can be a symptom of systemic (whole-body) diseases such as high blood pressure, and it can also be a sensitive symptom of inner-ear disease. An ear, nose and throat (ENT) specialist could examine you thoroughly to determine whether your tinnitus is due to some systemic problem or an ear problem. A hearing evaluation by an audiologist would be an essential part of this examination.

If your tinnitus is not due to medications but is due to an inner-ear problem, there are many treatment options. Hearing aids can be a very effective means of reducing tinnitus if you also have some degree of hearing loss. Tinnitus maskers are devices that present a low volume of a carefully selected noise to the ear. This noise blocks, or masks, the tinnitus. Drug therapy is an option if the preceding strategies are ineffective and if the patient is very debilitated by his or her tinnitus. Antidepressant and antianxiety medications have been used for this purpose, as have antiseizure medicines. Finally, biofeedback and auditory habituation, which helps patients learn to ignore the tinnitus, offer promise in helping people cope.

For more information, write to the American Tinnitus Association, P.O. Box 5, Portland, OR 97207. Alternatively, you can visit the organization's tinnitus information website.