Introduction: Vocal fold paralysis has several etiologies, one of them being lesion to the recurrent laryngeal nerve. It often affects left nerve, due to its greater extension in comparison to the right nerve. Specific chronic inflammatory processes such as tuberculosis, amyloidosis, sarcoidosis and other rare manifestations may damage the recurrent nerve, even though they are not common causes of vocal cord paralysis. Lesions that affect the mediastinum or others that cause significant pulmonary retraction, determine tracheal deviation with consequent vocal cord paralysis. Objective: To report a case of left vocal cord paralysis secondary to idiopathic chronic pulmonary fibrosis with consequent tracheal deviation. Case Report: Fifty-eight year-old female patient presenting chronic symptoms of intense dyspnea and dysphonia, almost aphonic, presented paralysis of the left vocal fold with important lateralization of the same. The patient underwent thyroplasty and demonstrated improvement in vocal communication for one year until her pulmonary disease worsened leading to her demise. Conclusion: Despite intensive investigation, the etiology of the pulmonary fibrosis remained unexplained, determining extensive tracheal retraction and consequent left recurrent laryngeal nerve palsy.