A 58-year-old engineer reports progressive right-sided hearing difficulty over 18 months. He has occasional unsteadiness but no rotational vertigo. Audiometry shows a moderate right sensorineural hearing loss with poor word recognition (40% at 60 dB SL). Left ear is normal.

Investigations

What is the appropriate next step?

• AMRI of the internal auditory canals with gadolinium
• BTreat empirically as Ménière's disease
• CRepeat VEMP in 6 months
• DReassure and discharge