Mr. N. is a 72-year old retired forester. Approximately a year ago, Mr. N. began to experience difficulties breathing, particularly in the evening while reclining. About 9 months ago, he began to experience speech difficulties as well. His speech became slurred and very unclear, particularly in the evening. For about the last 7 months, Mr. N. has increasingly been swallowing the wrong way, particularly when eating spicy food.