A 52-year-old man presents with a 6-month history of low-frequency roaring tinnitus in the left ear, accompanied by progressive hearing loss, fullness in the ear, and episodic vertigo. Audiometry shows a characteristic low-frequency sensorineural hearing loss (bone conduction better than air conduction at 500 Hz). Caloric testing is normal. What is the most likely diagnosis?
A 68-year-old woman with a 3-year history of bilateral high-frequency tinnitus and progressive hearing loss presents for evaluation. She denies vertigo, aural fullness, or otalgia. Pure-tone audiometry shows symmetric bilateral sensorineural hearing loss worse at 4000 Hz (the 'notch'). She has no history of noise exposure. Otoscopy is normal. What is the most likely etiology of her tinnitus?
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