DEAR DR. ROACH: I’m an 83-year-old man in good health who exercises regularly. I came down with a common cold and was prescribed a five-day course of prednisone (50 mg). I’ve taken two so far. I’ve had tinnitus for as long as I can remember, but at around 3 a.m. this morning, I had the loudest tinnitus by far that I’ve ever had. It has quieted down some.

My cold symptoms have diminished considerably. I’ve stopped taking the prednisone. Is there a connection between the two? — S.B.

ANSWER: I was unable to find an association between corticosteroids like prednisone and the worsening of tinnitus (a sound you can hear that nobody else can, often a ringing or buzzing sound). The most likely cause of tinnitus in an 83-year-old is hearing loss, which might be due to loud noise exposure or just due to age.

Prednisone and similar drugs have occasionally been shown to improve tinnitus (from several different causes), so I am at a loss as to why it seemed to make yours worse.

If your cold plugged up your Eustachian tube (which equalizes pressure in your ear), then your hearing could have gotten worse and could have also made the tinnitus worse. This still would have nothing to do with prednisone, just the cold.

I do have to comment that I do not agree with high-dose prednisone for people with uncomplicated respiratory infections. Five days of prednisone is generally safe but not completely safe in an 83-year-old. I have seen acute delirium from this dose of prednisone, which is a scary and dangerous sudden change in mental status.

Since most people do well with treatment like Tylenol, rest and fluids, I recommend against high-dose prednisone even if it had nothing to do with the tinnitus.

DEAR DR. ROACH: I have family members in their 70s who have gotten hip and knee replacements. A regional orthopedic practice with specialties in hip and knee replacements has offered to “move them up” on the surgical schedule for an extra out-of-pocket payment of $5,000. By the time surgery is indicated for someone, usually their pain and discomfort influence their decision.

As a retired clergyperson, I see this as a form of extortion. What are the medical ethics governing this practice? Is there any recourse besides paying or having to wait longer in pain? — J.D.M.

ANSWER: In my opinion, allowing people to get faster care by paying more is unethical. This practice breaks a key principle of medical ethics and denies equitable access to care, which should be based on need and not a person’s ability to pay.

Expedited access to care breaks a second core principle of medical ethics, called non-maleficence. (This is clearly expressed in the Oath of Hippocrates: “First, do no harm.”) Expediting care to people who can pay more but may have the same or an even lesser need than others who are waiting causes suffering to those who cannot or are unwilling to pay.

The American Medical Assocation and the American College of Surgeons do not support the policy of payment for expedited services. But some experts have argued that increased efficiency (by using idle operating room time, for example, for those who are willing to pay more) and the principle of patient autonomy (the patient’s right to make the personal choice of using their money) make expedited access for a fee an ethical choice.

Not all ethicists agree on the answer to this question. Personally, I believe the fairness, non-maleficence and equity arguments outweigh the efficiency and autonomy arguments.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved