Hyperactive disorders related to neurovascular compression have been described for several cranial nerves of which trigeminal neuralgia and hemifacial spasm are the best known. The present report on four patients, in conjunction with previous reports, suggests that paroxysmal staccato tinnitus might be considered an auditory hyperactivity disorder of the eighth cranial nerve. The present patients reported attacks, usually lasting 10-20 s, of loud monaural tinnitus with a staccato character (eg, clattering or sounding like a machine gun). The attacks occurred very frequently, sometimes every minute. The attacks were spontaneous but they were also provoked by certain head positions or by exposure to loud sounds. Most of the patients did not reveal any significant eighth cranial nerve sensory loss and thus it is probably not advisable to rely on any specific test result for this diagnosis. Instead, it is suggested that a diagnosis of paroxysmal staccato tinnitus can be based on the history as the symptoms are both stereotypic and very specific. Furthermore, low doses of carbamazepine, although not effective for the general population of tinnitus patients, relieved the symptoms.