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BackgroundNasogastric tube syndrome is a rare but life‐threatening complication of nasogastric tube placement due to acute upper airway obstruction caused by bilateral vocal cord paresis.Case PresentationAn 86‐year‐old woman was brought to the emergency department with acute stridor. She had been diagnosed with stroke 106 days prior, and an 8F nasogastric tube was placed on the day following the diagnosis. A laryngeal fiberscopy revealed bilateral laryngeal edema and bilateral vocal cord palsy. Nasogastric tube removal and intubation were carried out, and the stridor disappeared. Two days later, a tracheostomy was performed. Unfortunately, the patient's vocal cord function had not improved at the 1 month follow‐up upon assessment with a laryngeal fiberscope.ConclusionLong‐term small‐bore nasogastric tube placement can cause upper airway obstruction due to bilateral vocal cord palsy.