A 36-year-old woman presented with a history of change in voice of 1 month's duration and difficulty swallowing and episodes of nasal regurgitation of 6 days' duration. Examination revealed paralysis of the right vocal fold and the right side of the soft palate. On further investigation, she was found to have syringomyelia with syringobulbia and a Chiari type I malformation. She underwent foramen magnum decompression surgery and was followed up for 1 year. Her dysphagia and nasal regurgitation resolved, but no functional improvement was seen in either her vocal fold or palate.