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Barbara Cooke says the phantom noise she hears is "like when you put a conch shell to your ear."
She is not talking about a sunny, sandy, soothing surf sound. What the busy Center City grandmother experiences is more like a tidal wave - an inescapable roar that drowns out everything else.
Cooke, 71, has tinnitus, the perception of sound in the absence of an environmental source.
An estimated 50 million Americans have this spooky, incurable problem, which is growing, especially among veterans and aging baby boomers. Most people adapt and stop noticing it. But Cooke is among the hapless 10 million or so who are tormented and exhausted by it.
"It was so sudden," she recalled of the onset of her tinnitus late last year. "It drove me crazy. I was probably close to suicidal. I just sat and cried."
The good news is that helpful therapies are available. Cooke is getting relief from one of the newest, developed by Neuromonics Inc. of Bethlehem, Pa. A portable, customized audio player, combined with counseling and monitoring by an audiologist, aims to retrain the brain to filter out the noxious stimulation.
"I can still hear it, but it doesn't bother me anymore," Cooke said last month at Thomas Jefferson University Hospital's Balance and Hearing Center.
Audiologist Elizabeth Gray smiled and said, "Your brain is changing its perception."
Tinnitus - from the Latin word tinnire, meaning "to ring" - plagued Van Gogh, Beethoven, Oscar Wilde, and more recently Rosalynn Carter, David Letterman, and William Shatner, to name a few.
In many cases, including Cooke's, tinnitus accompanies hearing loss, a fairly inescapable part of aging. But it can also be triggered by head injury, ear infections, jaw dysfunction, medicines ranging from chemotherapy to aspirin, and a bane of modern society: loud noise.
Tinnitus has become an active area of research over the last 20 years, yet scientists cannot completely explain the phenomenon. One theory is that the inner ear's sound-receiving cells become injured, so they can't properly send signals to the auditory nerves.
In any case, tinnitus - like pain - is highly subjective. The pitch, loudness, frequency, and type of sound vary from patient to patient.
Many treatments have been tried, including certain drugs, herbal supplements, lasers, electromagnetic waves, hyperbaric oxygen, acupuncture, biofeedback, hypnosis, hearing aids, relaxation exercises, and sound-masking devices.
Because the evidence of effectiveness is sketchy, health insurers generally will not cover treatment - and quack remedies abound.
"I went into Google and searched 'tinnitus treatment' and got a billion hits," said Tom Willcox, an ear, nose, and throat doctor and director of the Jefferson hearing center.
One time-honored area of research exploits the brain's amazing ability to focus on new or significant sounds, while ignoring unimportant ones.
Initially, this led to portable or bedside devices that basically "blotted out tinnitus with another sound," said fellow otolaryngologist William H. Martin, who heads the renowned tinnitus research program at Oregon Health & Science University.
"Sometimes you can introduce sound in one ear and treat tinnitus in the other ear. Go figure that," said Martin, who previously directed Temple University's Garfield Auditory Research Laboratory. "And you can use low-frequency sound, like an ocean sound, to mask high-frequency tinnitus."
Masking therapy has evolved to use low-level, broadband sound that competes with - rather than overrides - the tinnitus. The goal is to retrain the brain to ignore the disruptive noise, the same way it stops noticing highway traffic or the neighbor's barking dog.
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