We present a case of left recurrent laryngeal palsy in a 50-year-old lady who was the sole manifestation of critical mitral stenosis. In the absence of a giant left atrium, pulmonary artery hypertension with entrapment of recurrent laryngeal nerve (RLN) in the aortic window may have contributed to compression of left RLN. Mitral stenosis was relieved with balloon mitral valvotomy which lead to significant improvement in her hoarseness.