A 57-year-old man presented with an 8-week history of progressive hoarseness and shortness of breath. His symptoms were unresolved after an initial course of antibiotics and 1 month of proton pump inhibitor therapy. He was not taking an angiotensin-converting enzyme inhibitor. His medical history was remarkable for well-controlled asthma, diabetes mellitus, and hypertension. He denied any weight loss, easy bleeding, or hemoptysis and is a lifelong nonsmoker, although he reported secondhand exposure. Physical examination revealed a well-nourished man with a high-pitched voice and mild biphasic stridor. Oxygen saturation was 97% on room air, and no accessory muscle use was noted.