by Neil Bauman, Ph.D.
© December, 2022
I’ve written about several different kinds of weird tinnitus including “Moving Tongue Tinnitus” (1), “Nodding Chime Tinnitus” (2), “Reactive Tinnitus” (3), Pulsatile Tinnitus (4), “Squeaking Tinnitus” (5), “Touch-Sensitive Tinnitus” (6), “Exploding-Head Tinnitus” (7) and several other kinds of tinnitus including, “Gaze-Evoked Tinnitus”. These and the above listed kinds of tinnitus are all more fully explained in the 8th edition of my book “Take Control of Your Tinnitus—Here’s How” (8).
However, somehow I totally neglected to explain another strange kind of tinnitus variously called “Typewriter Tinnitus” or “Morse Code Tinnitus”.
What Is Typewriter Tinnitus?
The obvious hallmark of typewriter tinnitus is its intermittent staccato tinnitus that sounds for all the world like the staccato sounds of an old-fashioned typewriter, the clicks of a Morse code key, the sound of a machine gun firing, or even the sounds of popcorn popping. (9)
One man explained his typewriter tinnitus thus.
I would describe my typewriter tinnitus as a machine gun ticking over, and then going full pelt at various intervals throughout the day. Essentially, during the day I always hear a sound that varies from louder to softer.
A lady hears her tinnitus as what sounds like Morse code. She related,
One day I started hearing noises in my right ear. It was (and still is) a weird sound—a Morse code type of sound—like I was receiving a message from aliens. After a while I started hearing it in my left ear as well, but the tone was a bit different.
Note: You typically only hear typewriter tinnitus in one ear, but it can (rarely) occur in both ears at the same time. (9)
One study of 22 participants revealed that 21 participants experienced their typewriter tinnitus in only one ear, while one heard it in both ears. Of the 21 participants with unilateral typewriter tinnitus, 10 heard it in their right ears and 11 heard it in their left ears, (10) thus indicating that typewriter tinnitus obviously has no specific preference for either the left or right ear.
Typewriter tinnitus is typically intermittent with periods of silence ranging from minutes to hours to days to months between episodes. For example, one man reported,
I have unwanted clicking in my left ear. It all started when I woke up in January with a clicking sound. I didn’t hear it again until July. It’s gone on for hours, days, weeks or months and then stops only to return hours, days, weeks or months later.
Another man with typewriter/Morse code tinnitus related,
I’ve got some intermittent typewriter tinnitus. It’s never constant, but clicking/beeping. Sometimes it stays away for minutes; sometimes it happens more often.
Typewriter tinnitus may occur as the only symptom, or it may occur in conjunction with other symptoms. For example, in the study of 22 participants (mentioned above), 8 participants (36%) complained of typewriter tinnitus without any other neuro/otologic symptoms, while the other 14 (64%) had combined neuro/otologic symptoms. Of these participants, 3 had both typewriter tinnitus and hemifacial spasms in the same ear, 9 had vertigo, and 2 complained of both hemifacial spasms and vertigo. (10) This reveals that, unlike in other types of tinnitus, a full half of the typewriter-tinnitus participants experienced periodic bouts of paroxysmal vertigo. (9)
“Paroxysmal” is just the fancy medical term used to describe spasms or convulsions, or the sudden onset of a symptom, especially one with recurring manifestations. Thus paroxysmal vertigo is not constant vertigo. Rather, it is intermittent vertigo attacks that occur sporadically just as does the typewriter tinnitus it accompanies.
What It’s Like to Have Typewriter Tinnitus
Just like it is in other kinds of tinnitus, typewriter tinnitus is unique to the person experiencing it, but the following examples (and other examples previously mentioned) give you an idea of what it can be like. For example, one lady wrote,
My typewriter tinnitus came on suddenly one night while in bed when I was 7 months pregnant. I had no experience with tinnitus before that. It was terrible for months and it was all I could focus on day or night. I thought there was no way I could go on living like that. I thought it would go away once I had given birth, but it stuck around. I started using white noise to sleep and tried to avoid quiet places during the day. If there was enough background noise I could avoid thinking about it too much.
A man, somewhat humorously, explained,
My Morse code tinnitus started only a week ago and it can be maddening. My wife jokes that my ears are communicating to me that I should do more household chores.
Another man reported,
My tinnitus is a very faint rapid-firing beep (in addition to my high pitch tinnitus), sounds just like a Morse code sound effect from a movie.
The Morse code version of typewriter tinnitus can also be a clicking sound. As one person explained,
I have Morse code tinnitus, but it’s more like click, click, click. It’s not constant—just a few times throughout the day.
Typewriter tinnitus can also combine with loudness hyperacusis to form reactive (typewriter) tinnitus. Here is one man’s story.
The past couple of days I have had a new symptom on top of my normal “eeeeee” tinnitus. I have been getting a sort of beep-beep-beeeeeeep-beep, almost like Morse code beeping.
It also seems to react to noise. It will beep from certain noises like this morning it was reacting to birds chirping outside my window and the radio in my car.
At times, it’s barely audible in a quiet room, mostly in mornings. But sometimes it seems to go with the sound around me and can increase or decrease. I feel like I’m very sensitive to high-pitched or high-frequency sounds right now, but I don’t know if that’s because my anxiety is really heightened just now.
I feel like my tinnitus even reacts to the TV. I get a sort of strange metallic tapping noise from the sounds from the TV—not all the time, but it does happen.
Another person with reactive tinnitus explained,
I recently developed Morse code tinnitus. My beeping is lower-pitched and typically reacts to desk fans and computer fans. It also beeps on its own when I’m lying on my side sleeping. It can be beeping gently, barely audible, but sometimes it becomes almost a constant tone.
What Causes Typewriter Tinnitus?
Unlike most kinds of tinnitus, the underlying cause of typewriter tinnitus is known (or at least is thought to be known). Typewriter tinnitus results from pressure compressing certain nerves by blood vessels, fascia, muscles, tendons or bones (vertebrae).
This compression is usually caused by improper posture, muscle weakness, repetitive strain activities or injuries to muscle, ligament and tendon groups. It can also result when your neck vertebrae are out of proper alignment such that they put pressure on certain nerves. (9) Thus, if you have typewriter tinnitus, you probably also have some problems with your jaw, neck, shoulders or upper back being painfully tight.
For example, an artery or vertebrae compressing a cranial nerve can over-stimulate that nerve, triggering hyperactive activity in that nerve—with or without loss of function. Examples of hyperactive disorders associated with microvascular compression or vertebral subluxations include trigeminal neuralgia (the trigeminal—5th cranial nerve), hemifacial spasms (the facial—7th cranial—nerve), (10) and certain tinnitus and balance conditions (the vestibulocochlear—8th cranial nerve).
The vestibulocochlear nerve can be split into its two main components—the cochlear branch (causing typewriter tinnitus) and the vestibular branch (causing paroxysmal vertigo). Both of these conditions arise from the same basic cause—pressure on these nerves.
One neurotologist explained that when there is pressure on a nerve, it doesn’t work properly and it can misfire, resulting in the clicking typewriter-tinnitus some people hear.
Furthermore, as the facial, vestibular, and cochlear nerves lie close together in a bony canal, compression of the cochlear nerve can not only cause typewriter tinnitus, but can also trigger concomitant hemifacial spasms and/or paroxysmal vertigo. (10)
Paroxysmal vertigo is assumed to be caused by compression of the vestibular part of the 8th cranial nerve by the loop of the anterior-inferior cerebellar artery. This condition is also called vestibulocochlear nerve compression syndrome. (10)
The precise pathophysiological mechanism of neurovascular compression syndrome remains controversial. On the one hand, numbers of researchers consider that neurovascular compression of the cochlear nerve by a vascular loop of the anterior-inferior cerebellar artery (AICA) is the main cause of typewriter tinnitus. (11) Thus, they feel that the extent of the looping determines the severity of this form of tinnitus. (9)
On the other hand, other researchers have suggested that vascular looping around in the internal auditory canal does not always compress the 8th cranial nerve, and thus emphasize that “conflict”, rather than “compression”, is the correct understanding. (10)
This latter group think that the hyperactivity in the vestibulocochlear nerve is the result of “ephaptic” as opposed to “synaptic” transmission in the affected nerve. (10)
In plain English this means that instead of signals being passed from neuron to neuron via normal synaptic activity, if the myelin sheath that insulates nerves is “worn through” from the nerves being compressed and thus touching each other, essentially the nerves short together causing these extraneous typewriter tinnitus signals to be passed up to your brain.
That compressed nerves are at the heart of typewriter tinnitus, I have no doubt. However, I think researchers have overlooked the fundamental cause underlying typewriter tinnitus—namely that the nerves, rather than typically being compressed by arteries wrapped around them, are compressed by cervical vertebrae that are out of proper alignment and thus putting pressure on these nerves.
Notice that bodily position or motion greatly affects typewriter tinnitus giving credence to this view. For example, one man explained,
Overnight my typewriter tinnitus generally fades away, then ramps up when I get up. For example, this morning I woke up and without moving I realized I couldn’t hear any tinnitus at all. After an hour, I sat up and 10 minutes later the tinnitus returned. If I lie down, after a few minutes the full-pelt machine gun will disappear or slow down considerably. My machine gun sound often re-appears when I am standing.
This is likely because when you lay down you typically relax and this removes much of the pressure on the nerves. When you stand up again, your muscles/tendons tighten up on the vertebrae to hold you upright and thus the pressure increases again. Consequently, you once more hear your typewriter tinnitus.
Notice that in the following report, muscle activity definitely affects typewriter tinnitus. As one man noted,
I’m someone who can move their ears at will. I just noticed that by doing so, I can make my Morse code tinnitus turn into a continuous sound. When I flex my neck muscles it increases my regular tinnitus.
Manipulation, massage and exercise can often help reduce typewriter tinnitus. One lady reported,
I started seeing an osteopath that specializes in TMJ about 9 months after my typewriter tinnitus started. I had a few sessions with him and it temporarily helped (meaning maybe for a day or so the tinnitus went away, but then it came back just as strong). I gave up on the osteopath but he did give me some exercises to regularly practice where I would very subtly move my jaw right and left (the smallest movement possible), and make sure I didn’t clench my jaw (a bad habit of mine), plus a few other tips. I kept those practices up and with time, my tinnitus became less and less noticeable. I am not sure if it’s related to the exercises or not. Every once in a while it does come back but usually only lasts 1-2 days and then fades away again.
That relaxation does relieve the pressure on the nerves is obvious. To that end, one man explained how alcohol relaxes him and thus helps his typewriter tinnitus.
My Morse code tinnitus goes away when I drink alcohol. It stays away if I have a drink or two every night. But as soon as I stop drinking (no drinks for 2 nights at the moment), it comes right back.
Another person with Morse code tinnitus related his level of stress to his tinnitus. He explained,
I have it sometimes in one ear, but this tinnitus is more in response to stress. I think it is a result on me clenching or holding my muscles in a tense position.
Diagnosing Typewriter Tinnitus vs. Middle Ear Myoclonus
Doctors sometimes mistake typewriter tinnitus for myoclonus (muscle contractions) in the middle ear such as tonic tensor tympani syndrome (TTTS) See “Do I Have Tonic Tensor Tympani Syndrome?” (12).
There are some basic differences between these two conditions that can help you figure out which condition you have.
The main diagnostic feature of typewriter tinnitus includes short-lasting attacks of unilateral, staccato tinnitus. In one study, all subjects described their tinnitus as tapping, clicking, or crackling in nature. (10)
Furthermore, typewriter tinnitus is more associated with symptoms such as dizziness/vertigo, facial spasms and specific head movements, whereas middle ear myoclonus is more associated with noise. (11) Furthermore, people with middle ear myoclonus tend to have lower loudness discomfort levels due to previous exposure to sudden, unexpected, loud sounds.
In addition, since carbamazepine therapy often reduces or eliminates typewriter tinnitus, doctors can use the success (or lack of it) as a diagnostic tool. For example, studies have revealed that carbamazepine does not significantly benefit people with other kinds of tinnitus. However, one study revealed a 100% positive response to carbamazepine within two weeks. Therefore, researchers concluded that a prompt response to low-dose carbamazepine may be the most reliable diagnostic criterion of typewriter tinnitus. (10)
MRI scans and patient histories can also help in diagnosing typewriter tinnitus. However, a successful response to initial carbamazepine treatment (within 2 weeks) usually gives a more reliable diagnosis than do radiological or neurophysiological findings in people with typewriter tinnitus—assuming of course, that the cause of their tinnitus is due to the cerebellar artery looping around the vestibulocochlear nerve. (9)
However, note that radiological (MRI) or neurophysiological abnormalities (vascular loops around the nerve) are of limited diagnostic usefulness since they are not present in everyone with typewriter tinnitus. (10)
Prominently missing from this discussion are upper cervical chiropractic treatments. If typewriter tinnitus is due to vertebral subluxations, then the success of upper cervical chiropractic adjustments that eliminate typewriter tinnitus should also be included here.
Treating Typewriter Tinnitus
Since nerve compression is thought to be the cause of typewriter tinnitus, the obvious way to eliminate such tinnitus is to remove the pressure on the offending nerve.
This can be done in at least three ways. In order of being the least intrusive and with the fewest side effects, these methods are:
- Upper cervical chiropractic adjustment to precisely align the appropriate vertebrae, which takes the pressure off the offending nerve.
- Drug therapy using low-dose carbamazepine to relax tissues around the compressed nerve and thus remove the pressure on it.
- Nerve decompression surgery to remove tissue from around the nerve that is compressing it.
Let’s look at each of these in turn.
Upper Cervical Chiropractic
Doctors seem to be clueless that subluxations in the cervical vertebrae are very likely the underlying cause of typewriter tinnitus. Rather, they focus on medical treatments such as drugs or surgery rather than on chiropractic adjustments. (Note that subluxations occur when your vertebrae are not properly aligned.) When vertebrae are not properly aligned they can put pressure on the corresponding nerves (and arteries). The result can be typewriter tinnitus and the associated balance problems. Two likely vertebrae causing this kind of problem and cervical vertebrae C2 and C4.
If your typewriter tinnitus comes or goes when you change positions, there is a high probability that your typewriter tinnitus is the result of your head, jaw, neck or shoulders not being in proper alignment. For example, one man explained,
My intermittent typewriter tinnitus bothers me the most during the day. During the night it is almost always completely gone. Waking up I’ll get a very loud hissing. As soon as I get out of bed, the hissing goes away and the beeping/clicking kicks in again.
When an upper cervical chiropractor (not a conventional chiropractor) precisely adjusts and aligns these vertebrae, it takes the pressure off the nerve (and/or arteries) and the downstream problems (tinnitus, vertigo) typically go away.
For example, one man recently went to see Dr. Michael Burcon, the world’s leading upper cervical chiropractor, in relation to ear problems. This man had severe typewriter tinnitus. Upon examination and x-rays, Dr. Burcon found his C4 vertebra was way out of proper alignment, thus causing his typewriter tinnitus.
You may only need one treatment if the adjustment “holds”, but if your neck has been “out” for any length of time, it is easy for the vertebrae to slip back into their old positions. Consequently, you may need to have several adjustments until the affected vertebrae “hold” and stay in their proper positions.
If you have typewriter tinnitus, seeing an upper cervical chiropractor may be all you need to do. You can find an upper cervical chiropractor by going to http://www.upcspine.com/ and clicking on the “practitioners” tab.
Researchers have discovered that low-dose carbamazepine seems to help people with typewriter tinnitus. (Note that carbamazepine is an anticonvulsant drug used to treat epilepsy and neuralgia [nerve pain]. It is not approved to treat tinnitus of any kind).
It seems that carbamazepine-mediated inhibition of the voltage-gated sodium channel may suppress ephaptic (touching as opposed to synaptic) axonal transmission in the affected cochlear nerve. (10) This sodium-channel blocking mechanism eases the compression on cranial nerves like the cochlear nerve, (9) and thus alleviates typewriter tinnitus, at least temporarily.
How effective is carbamazepine therapy? In one study, the participants had their typewriter tinnitus for between 2 weeks and 10 years. (10) They all exhibited partial or complete reduction in their tinnitus in response to carbamazepine. Specifically, 3 of the 22 participants (14%) achieved complete remission of their typewriter tinnitus while 19 participants (86%) achieved partial remission of their typewriter tinnitus. (9)
In terms of the associated symptoms, the symptoms abated in 100% of those with paroxysmal vertigo and in 60% of those with hemifacial spasms. (10)
With carbamazepine therapy, you typically take a dose of between 200 and 400 mg/day depending on your body weight. When a definite response to carbamazepine becomes evident, typically in two weeks or so, you reduce the daily dose to the minimum effective level (typically 100 mg/day in most cases). (10)
The good news is that all participants in this study exhibited prompt symptom improvement within 2 weeks of the commencement of low-dose carbamazepine. (10)
However, the bad news is that carbamazepine is basically just a band aid solution. Studies reveal about 60% to 100% of the people who had this therapy found their typewriter tinnitus came back when they stopped taking carbamazepine for a few days. (2, 3)
That is why there is a continued need to take a maintenance dose of carbamazepine. However, even a maintenance dose is not necessarily enough to prevent typewriter tinnitus from coming back. Eventually it just stops working. As one man explained,
Carbamazepine helped me for only 5 months, then the effect vanished.
Furthermore, the longer you take carbamazepine, the less effective it becomes. For example, another man related,
I get a loud crescendo of tapping that lasts for about 10 seconds and then suddenly cuts out. These bouts occur every 1 to 2 minutes. At the peak of each episode, I briefly feel disorientated and unbalanced. I can’t drive or function normally at all.
I told my doctor and literally begged him to prescribe carbamazepine. The relief was instant, I was walking around proclaiming a miracle—for about 2 weeks. Then it all started up again, slowly at first, but rapidly worsened. I increased the dose and once again the carbamazepine relieved the clicking for a while. I realized I can’t keep increasing the dose so I am now taking 150 mg twice a day and putting up with the tapping. The carbamazepine seems to be stopping the worst of the crescendos but I don’t see myself being able to live with this.
Thus, carbamazepine therapy is not a fundamental cure for typewriter tinnitus although it is currently the most commonly-prescribed medication for this kind of tinnitus.
At the same time, you need to be careful when taking this drug because not only is carbamazepine ototoxic, it also has potentially serious adverse side effects such as serious hepatic impairment, bone marrow suppression, (11) leukopenia and thrombocytopenia. (10)
Nerve Decompression Surgery
If your typewriter tinnitus is caused by the anterior-inferior cerebellar artery looping around your cochlear nerve and compressing it to some degree, doctors can perform nerve decompression surgery. The aim of nerve decompression surgery is to either remove whatever is pressing on the nerve or open up any narrow spaces to give the nerve more room, or both. Doctors typically use MRI scans to diagnose this condition.
Sometimes this surgery is successful, but other times it doesn’t work, thus revealing as mentioned previously, that the cerebellar artery looping around the cochlear nerve isn’t necessarily the cause of typewriter tinnitus. As another man explained,
I have had typewriter tinnitus for 2 years. I had microvascular decompression surgery and it didn’t help me. Most of the time it is worse than before the surgery. It’s so unbearable that I considered assisted suicide. I cannot live with it.
That is why I suggest that you first go to a upper cervical chiropractor and make sure all your cervical vertebrae are in proper alignment so they are not pressing on any nerves and thus precipitating typewriter tinnitus.
For further information on upper cervical chiropractic treatments, see the section on “Chiropractic Treatments” in Chapter 26 of my book “Take Control of Your Tinnitus—Here’s How” (13), or you can read more about this form of chiropractic in my comprehensive article on “Meniere’s Disease” (14).
(9) Morrison, James. 2021. Typewriter Tinnitus—An Overview. TinnitusAndYou. https://tinnitusandyou.com/typewriter-tinnitus/
(10) Sunwoo, Woongsang., Jeon, Y., Bae, Y. et al. 2017. Typewriter tinnitus revisited: The typical symptoms and the initial response to carbamazepine are the most reliable diagnostic clues. Sci Rep7, 10615 (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587715/.
(11) Han, Jae Sang, et. al. 2020. Typewriter tinnitus: An investigative comparison with middle ear myoclonic tinnitus and its long-term therapeutic response to carbamazepine. Auris Nasus Larynx. Vol. 47. Issue 4 Aug 2020. Pages 580-586. https://www.sciencedirect.com/science/article/abs/pii/S0385814620300250.