some, but not all, patients also describe episodic changes in their voice. this may be due to unilateral contractions in the muscles controlling the vocal cords. one patient reported that this could be triggered by loud or prolonged talking and would typically last a few minutes. if the episode was mild, their voice would return to normal within a few minutes. if the episode was severe, it would progress into severe choking. two patients also reported a sensation that their tongue was “fat” during the choking episodes. this may be due to contraction of the palatoglossus muscle. the combination of choking and a sensation of a “fat” tongue may lead to a misdiagnosis of an allergic reaction.