A 59-YEAR-OLD WOMAN WITH A HISTORY OF gastroesophageal reflux and hypercholesterolemia presented with a sudden hearing loss in her left ear. Her primary care physician had started her on an oral steroid regimen, but she reported no improvement in her hearing. After an audiogram revealed a high-frequency hearing loss 5 months earlier, she began using a hearing aid in her left ear. She also had an approximately 6-year history of profound hearing loss in her right ear, the cause of which was unknown. She denied having tinnitus or vertigo. She also denied a history of otologic disease, autoimmune disease, bleeding disorders, or otologic or neurologic surgery. She had no family history of bleeding disorders, autoimmune disorders, or diabetes. Physical examination revealed intact tympanic membranes. The findings of a cranial nerve examination were normal. An audiogram revealed profound sensorineural hearing loss in the right ear and moderate to severe sensorineural hearing loss in the left ear, with a 4-frequency pure-tone average of 61 dB. The patient had normal type A tympanograms bilaterally and 0% speech discrimination in both ears. There was no prior audiogram for comparison. The results of coagulation panels, viral serologic analysis, and autoimmune antibody screening examinations were all unremarkable. Magnetic resonance images (MRIs) of the brain and internal auditory canals were obtained (Figures 1, 2, and 3). What is your diagnosis?
