Shy-Drager syndrome presenting as Menière's disease

A 59-year-old patient with a history of Menière's disease is presented. She developed signs of progressive autonomic failure suggesting a diagnosis of Shy-Drager syndrome, a rare degenerative neurologic condition of unknown etiology. The most common otolaryngologic presentation of this syndrome is with stridor attributable to abductor paralysis of the vocal cords. The association with endolymphatic hydrops has not been previously described.