Bilateral  vocal fold immobility  is a rare and life threatening manifestation of diseases presenting as dyspnea, dysphonia and dysphagia. Management depends on underlying etiology,  respiratory performance, airway patency, vocal ability, and quality-of-life priorities. In this context  unusual presentation of underlying malignancy and management  in patient presenting with  bilateral vocal fold immobility(BVFI) without examination and radiological finding of growth.