Unilateral vocal fold paralysis is frequently encountered during ENT practise. It may result from many different conditions and it always should be regarded as a sign revealingan underlaying disease that can be located anywhere along the traject of the tenth cranial nerve or at the cricoarytenoidjoint being malignancies and trauma the leading causes. Etiology, glottal characteristics and compensative maneuvers, and individual factors such as comorbility or age must be considered when treatment options are proposed to the patient. A case of an uncommon etiology for unilateral vocal fold paralysis, an aortic aneurysm, is presented and considerations about the management of this condition are provided.