A 48-yr-old woman comes to the office because of a nasal-sounding voice. She has been treated in the past for chronic sinusitis and asthma. A year ago, she had balloon rhinoplasty to enlarge her sinuses. Today, she says that she first noticed the nasal-sounding voice a week after surgery, but it has become more apparent over the last 3 mo.
Today, she says it feels as though air escapes through her nose while speaking, giving it a nasal quality. Her voice is better in the morning and worse later in the day. She says she does not have dysphagia but notes occasional nasal regurgitation of liquids but not food. She denies diplopia, drooping eyelids, loss of smell or taste, and difficulty with balance or gait. She denies having arm and leg weakness and numbness.
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