Vocal cord paralysis can be due to neurogenic cause, trauma due to surgery, or mechanical fixation of the cords. Diagnosis of the underlying cause leading to paralysis of the vocal cords is important. Most commonly, there is paralysis of recurrent laryngeal nerve. Treatment depends on the cause and whether the cord paralysis is unilateral or bilateral. Unilateral paralysis patients usually present with change in voice, regurgitation, and difficulty in swallowing. One-third of them they show spontaneous recovery, due to compensatory movement of opposite healthy vocal cord. Speech therapy is useful during initial conservative management period. In rest of the cases, vocal cord medialization procedures are performed. As for bilateral vocal cord paralysis which is troublesome entity, patients present with severe symptoms of respiratory distress, stridor, and aspiration. Voice is usually normal in bilateral paralysis cases but change in pitch, poor intensity, and voice fatigue are the complaints. The primary objective is to relieve patients’ dyspnea. There are different treatment options available for bilateral vocal cord paralysis such as tracheostomy, arytenoidectomy, cordectomy, botulinum toxin injection, re-innervation procedures. All these procedures have been applied in with varying success. Unilateral cord paralysis is more common and has better prognostic outcomes as compared to bilateral vocal cord paralysis.