Aim of the study: We would like to highlight the diagnostic challenges and the management of idiopathic unilateral vocal cord paresis in a young girl. Hoarseness is a common presentation to the otorhinolaryngology department. Nevertheless, this entity keeps many physicians in a quandary, especially when it is secondary to vocal cord paresis without history of head and neck surgery, given the intricate anatomy of the vagus nerve. Case study: Herein, we are reporting a case of possible idiopathic unilateral vocal cord paresis in a young girl who presented with one-week history of hoarseness and cough. The patient had a prior surgery for the repair of transposition of the great arteries done in infancy. Flexible endoscopy revealed unilateral vocal cord immobility. Computed tomography revealed no new finding causing vocal cord paresis. The patient was referred to a tertiary centre for injection laryngoplasty. Conclusion: Unilateral vocal cord paresis may be caused by a myriad of aetiologies, which adds to the complexity of diagnosing and treating this entity. We would like to highlight various possibilities for the management of this condition.