Right vocal cord paralysis caused by a fish bone - a case report

Vocal cord paralysis (VCP) is most commonly attributed to central or peripheral causes. Peripheral etiologies can be further classified as traumatic, neoplastic, inflammatory, congenital, idiopathic, or other. Esophageal perforation caused by a foreign body leading to VCP, with hoarseness as the initial symptom, is a rare clinical presentation. A 49-year-old male presented with a 1-day history of hoarseness. Flexible laryngoscopy revealed right vocal cord paralysis. Cervicothoracic computed tomography (CT) demonstrated a linear hyperdense shadow extending from the superolateral to inferomedial direction adjacent to the right side of the esophagus at the thoracic inlet level, closely related to the esophageal wall, suggesting a cervical foreign body with esophageal perforation. The patient underwent successful transcervical foreign body removal under general anesthesia. Postoperative recovery was uneventful. One-year follow-up flexible laryngoscopy showed normal bilateral vocal cord mobility. In patients presenting with isolated vocal cord paralysis—particularly those without a clear history of trauma—clinicians should consider not only intrinsic laryngeal, cervical, or central nervous system pathologies but also the possibility of foreign body-induced compression of the right recurrent laryngeal nerve. Chest CT is essential to avoid misdiagnosis or delayed diagnosis.