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A previously healthy 27-year-old man presented to the emergency department with abrupt-onset right-sided hearing loss and tinnitus, which progressed over 1 month. He had no vertigo, imbalance, aural fullness, headache or other neurological symptoms. General physical and otoscopic examinations were unremarkable. On tuning fork testing, Weber lateralised to the left, and Rinne testing showed air conduction was more sensitive than bone conduction bilaterally. Pure-tone audiometry confirmed high-frequency right-sided sensorineural hearing loss ( figure 1A1).