A 58-year-old man presents with 6 months of persistent right-sided, high-pitched, nonpulsatile tinnitus, worse at night. He reports gradually progressive difficulty understanding conversations in noisy environments on the right side. He denies ear pain, vertigo, neurological symptoms, or recent infection. He has no history of chronic ear disease. Medications include hydrochlorothiazide and atorvastatin. Otoscopy shows normal external canals and intact tympanic membranes bilaterally. Weber test lateralizes to the left; Rinne test is positive bilaterally. Cranial nerve examination is otherwise normal. What is the most appropriate next step in management?

Tinnitus (Management) — 58yo Man | Neurology | MCCQE1 Q#13417

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