Sal Gentile hasn't had a quiet moment in a year.
Last July, he started hearing sounds with no apparent source — hissing, rattling, waves crashing and something like machine shop noise. The sounds changed throughout the day but never stopped.
"The first two weeks were extremely difficult," said Gentile, 62, who lives north of Tampa in Odessa.
The retired IBM executive had no idea what was causing the persistent noise in his head.
"I was devastated, frightened, confused. It's loud, as loud as the human voice," he said.
A doctor told him he had tinnitus, pronounced TIN-uh-tus or ti-NIGHT-us, a perception of sound without an external source — essentially, noise that no one else hears.
The sound may be continuous or come and go. It may change pitch or character or volume. For some, it's hissing, roaring, whistling, chirping, clicking or a steady high-pitched tone. Others say it's like white noise, the fuzzy sound that occurs when a radio is between stations. (For a sample of some of the most common tinnitus sounds, go to www.ata.org/sounds-of-tinnitus. Be patient. It takes a moment for the page to load. )
The exact cause of the condition is unknown, but researchers believe that for most people, it's probably related to exposure to loud noise that damages the inner ear. The exposure can be over a period of time, or it can occur at a single event.
Other possible risk factors include thyroid disease, Lyme disease, fibromyalgia, heart disease, wax build up, medications, tumors or trauma to the head and neck. For some, all it takes to make the noise stop is a professional ear cleaning or stopping a certain medication.
But for most sufferers, tinnitus is permanent. The condition is also often associated with hearing loss; in such cases, getting a hearing aid helps many people. A hearing aid that can boost the volume of conversations, for instance, may drown out the tinnitus sounds or at least make them tolerable.
The American Tinnitus Association estimates that 50 million Americans have some degree of tinnitus. About 16 million seek treatment. About 2 million are so severely affected that they are considered debilitated by it.
According to the Veterans Benefits Administration, by 2008, tinnitus had become the most prevalent service-connected condition.
"The majority don't find it bothersome," said Paula Myers, chief of the audiology section at Tampa's James A. Haley VA Medical Center.
"Only a small subset have difficulty and need help to cope with it," said Myers, who has been working with tinnitus patients at the VA for more than 20 years.
"Tinnitus is prevalent, especially among military veterans, but 90 percent decline treatment after basic education is provided and say they don't pay attention to it."
Terry Foster, a 58-year-old Air Force veteran, has had tinnitus for more than a decade — a combination of high-pitched ringing and white noise. But it has become worse the past three or four years, especially at night.
He saw an audiologist at the VA clinic in Lakeland and was given a sound masking device to use at night. He also attended two educational sessions at the clinic.
"They taught me to use diversion or background noise to mask it. I turn on the TV, music, use a sound machine. I never sit in the quiet," said Foster. "It was the best education and taught me how to stop concentrating on the ringing and what to do when I am bothered by it, so I always have a plan of action to shift my attention to something else."
Gentile found help by visiting the American Tinnitus Association website, where fellow sufferers offered advice.
"Each and every day one of them gave me a coping mechanism to try," said Gentile. "I have sound machines all around my home. I have hearing aids that produce white noise. I use an iPod at the gym that plays heartbeats, ocean sounds. They all help you live with it."
Gentile also worked with a psychologist who helped him change his reaction to the noise so that he doesn't care about it so much.
"I still have bad days," he said, "But you just have to adjust your coping mechanisms."
Myers said that although there is no cure for tinnitus, there are many effective coping options. With sound machines, high-tech hearing aids, behavioral therapy and support groups, the torment can be lessened.
She urges people who think they have tinnitus to get a hearing test.
"In one study, 68 percent of patients who got a hearing aid also got relief from tinnitus," she said. "That's why the first step if you suspect tinnitus should be to get your hearing tested."
Contact Irene Maher at imaher@ tampabay.com.