We report the case of a 48-year-old woman, referred to the Intensive C
are Unit with community-acquired pneumonia, who was noted to have stri
dor of acute onset. Subsequent indirect laryngoscopy revealed bilatera
l abductor vocal cord paralysis, secondary to unsuspected carcinoma of
the oesophagus, requiring immediate tracheostomy. We highlight the im
portance of visualisation of the vocal cords in cases of stridor of un
certain aetiology.