the first case series was reported in 2018. with the addition of several patients, the core symptoms became clearer. all patients had severe, episodic choking and coughing. some patients also had episodic vocal changes presumably due to contraction of the laryngeal musculature. some patients had sensations of a ‘fat’ tongue (e.g. patient 1) presumably on the basis of contraction of the palatoglossus muscle. some patients could feel what side of their throat was contracting (presumably due to pharyngeal muscle contractions) and some patients could not lateralize the circumferential choking (presumably due to laryngeal muscle contraction).