This report describes the diagnosis and treatment of a 9 year old Thoroughbred gelding that presented to the Cornell University Equine Hospital with excessive coughing following a prosthetic laryngoplasty (tie-back) surgery. The horse in this report had a one-year history of making upper respiratory noise during exercise, was diagnosed with left laryngeal hemiplegia by the referring veterinarian (rDVM), and subsequently a laryngoplasty was performed. Post-operatively, the gelding displayed uncontrollable coughing episodes, which progressed over time. He was referred to the Cornell University Equine Hospital for persistent coughing and aspiration. Following a diagnostic work-up, the patient was diagnosed with dysphagia and aspiration pneumonia. In addition to medical treatment for pneumonia, the gelding received left vocal fold injections with RADIESSE® Voice, calcium hydroxylapatite (CaHA) microspheres, as a novel treatment for dysphagia.