My former classmate in elementary referred his father to me for evaluation and management because of two-months history of hoarseness and nonproductive cough. He has a 30 pack-years smoking history but apparently had quit smoking a few months earlier. He denied chest pain and dysphagia. On laryngoscopy, the left vocal fold was paralyzed. No laryngeal mass noted. I requested for a computed tomography (CT) scan of the neck and chest and a 6 x 7 cm mass was noted at the left hilar area. I referred him for CT scan guided biopsy of the mass. This is the normal vocal fold movements. Unilateral vocal cord paralysis occurs secondary to dysfunction of the recurrent laryngeal or vagus nerve innervating the larynx. Patients typically present with a fairly sudden onset of a “breathy” voice because of incomplete adduction of the paralyzed vocal cord. In addition, the patient may complain of his or her “voice going away” and shortness of breath. Normally, upon speaking, both vocal cords addu...