The clinical adage, "Push to tinnitus, then back off slightly," has been used to regulate aspirin dosage for intensive salicylate therapy. Its value in subjects with normal hearing was demonstrated in a study of seven healthy volunteers and 67 patients with rheumatoid arthritis. The dose of buffered aspirin was gradually increased until tinnitus was noted. In 59 subjects experiencing tinnitus, the serum salicylate level was invariably greater than 19.6 mg/100 ml (average, 30.4 mg/100 ml), although their aspirin dose varied from 12 to 36 standard 300-mg tablets daily.
However, tinnitus was not a reliable guide in 22 patients with preexisting hearing loss, as 15 of them did not experience it despite an average serum salicylate level of 43.1 mg/100 ml. Aspirin dosage should be increased with caution and monitored with serum determinations in this predominantly elderly group.