Brittany Kirch

A 58-year-old male presents with 1 day of severe vertigo associated with nausea and vomiting, tinnitus, and sudden-onset hearing loss. He reports several days of left-sided ear pain and discharge from his left ear. Vital signs reveal T 38.9C, HR 120, BP 138/96, RR 18, SpO2 99% on room air. He is ill-appearing with an HEENT exam notable for an inflamed left external auditory canal with purulent drainage and an erythematous tympanic membrane with evidence of perforation. He has left-sided hearing loss, left-beating horizontal nystagmus, and a mildly unsteady gait. He has leukocytosis with bandemia. CT head shows no acute intra-cranial process. What is the most likely diagnosis?