Spinning Into Silence

A 54-year-old woman presents to the clinic reporting two episodes of intense spinning sensations over the past 24 hours, each lasting about 3 hours and accompanied by nausea, vomiting, and difficulty walking. She also complains of a sensation of fullness and ringing in her left ear, with fluctuating hearing loss. The second episode occurred this morning, and she still has persistent tinnitus and muffled hearing. She denies headaches, photophobia, or neurological deficits. She has no significant medical history and takes no medications. Neurologic exam and brain MRI are unremarkable. Audiometry shows low-frequency sensorineural hearing loss in the left ear.