A 55-year-old woman woke 3 days ago unable to hear from her left ear, with mild vertigo and a sensation of ear blockage. She denies preceding URI, ototoxic drugs, or noise exposure. Otoscopy and tympanometry are normal (type A). Weber test lateralizes to the right ear and Rinne shows air conduction > bone conduction bilaterally. Audiogram shows the pattern marked **C** in the diagram. Which of the following is the most appropriate immediate management?
A 45-year-old man presents 36 hours after waking with complete deafness in his left ear, roaring tinnitus, and ear fullness. Otoscopy is normal bilaterally. Weber test lateralizes to the right (normal) ear; Rinne shows air-bone conduction is normal bilaterally. Pure-tone audiometry reveals the pattern marked **B** in the diagram — severe sensorineural hearing loss of 75 dB averaged across 0.5, 1, 2, and 4 kHz on the left, with normal hearing on the right. Speech discrimination on the left is 20%. No preceding URI, ototoxic exposure, head trauma, or vertigo. Which of the following is the MOST CRITICAL next diagnostic step to exclude a life-threatening structural lesion?
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