Laryngeal abductor paralysis (LAP) and stridor are well known features that occur in over one third of patients with multiple system atrophy (MSA).¹ The pathogenesis of LAP is thought to be crico-arytenoid abductor muscle denervation,² although there is a lack of consistent evidence of motor cell loss in the nucleus ambiguus.^2,3 More recently, dystonia of the laryngeal adductor muscle has also been proposed.⁴ LAP/stridor usually occurs in the advanced stages of the disease,⁶ and is considered to be a poor prognostic feature.^1,2 In contrast, some MSA cases have shown LAP initially, with most of these reported by otolaryngology departments.^5–7 However, there are no systematic surveys as to the extent to which MSA patients initially …