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The patients had both implantation and stimulation\u2010related side effects, which lasted for several months, impacting on their quality of life. The adverse effects appear to be due to recurrent laryngeal nerve paralysis\u2010related vocal cord hypofunction and stimulation\u2010related vocal fold spasms, however, their inter\u2010relationship is complex. In one of the patients, we were able to utilize the novel programming capabilities of the VNS device to reduce the laryngeal side effects without compromising therapeutic efficacy. 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