Laryngeal tuberculosis (TB) occurs in about 1% of patients suffering from pulmonary tuberculosis; however presentation of these patients with primary laryngeal symptoms is a rarity. In such situations it forms a diagnostic dilemma between laryngeal TB and the more common laryngeal carcinoma. Highlighting this dilemma we present our patient, a 76 year old male, farmer presenting with primary complaints of progressive dysphagia for 3 weeks. This patient happens to be our second case of laryngeal TB, presenting with primary laryngeal symptoms in a span of under 2 years. We present these cases to emphasize that although laryngeal tuberculosis presenting with primary laryngeal symptoms is a rarity, it must be considered when evaluating dysphagia or dysphonia in populations where TB is endemic. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(1); 40-42 DOI: http://dx.doi.org/10.3126/saarctb.v10i1.8676