A 9-year-old spayed female mixed-breed dog was evaluated because of dysphagia and coughing of 6 months' duration. The owner had also noticed a change in the dog's bark. The clinical signs were unresponsive to administration of amoxicillin, diphenhydramine, and metoclopramide hydrochloride. The dog also had a prior history of urolithiasis and bilateral otitis externa. On initial physical examination, oral evaluation revealed a fracture of the right maxillary canine tooth and atrophy of the left side of the tongue. Rectal temperature was 38.7°C (101.7°F), heart rate was 108 beats/min, and respiratory rate was 20 breaths/min. A gag reflex or cough could