A 55-year-old bank teller has episodes of dizziness with tinnitus lasting several hours. What is the most likely diagnosis?

The most likely diagnosis for a 55-year-old bank teller experiencing episodes of dizziness accompanied by tinnitus that lasts several hours is Meniere's disease. This condition is characterized by recurrent episodes of vertigo, tinnitus, and hearing loss, often occurring in “attacks” that can last several hours. The association of both dizziness and tinnitus points towards Meniere's disease, as these symptoms commonly occur together in this disorder due to increased fluid pressure in the inner ear.

While each of the other conditions listed can cause dizziness or vertigo, they do not typically present with the combination of prolonged tinnitus and vertigo episodes in the same way as Meniere's disease. Acoustic neuroma may manifest with similar symptoms but is less likely to present with the classic triad of Meniere's disease. Benign positional vertigo is usually triggered by changes in head position and does not lead to tinnitus or prolonged symptoms. Vestibular migraine can cause dizziness and vertigo but is less commonly associated with persistent tinnitus and typically links to headache patterns. Therefore, Meniere's disease aligns best with the patient's symptoms.