A 41-year-old woman complains of worsening hearing in her left ear for 6 months. She has also started to experience a mild ringing noise in the same ear for around a month now. There is no history of earache, ear fullness, otorrhea, or dizziness. There is no history of trauma.

She works as a history teacher in a local high school. Her students tell her that she has started speaking rather quietly since recently. Her medical and surgical histories are unremarkable. She is not on any medications. Her father had progressive hearing loss starting from a young age, but this was not investigated further.