Vocal cord paralysis is a multifacted problem that affects patients of all ages and presents initially to a wide range of healthcare professionals. It can cause laryngeal dysfunction ranging from slight hoarseness to life-threatening airway obstruction. When confronted with a patient with new onset vocal cord paralysis, the physician should determine the etiology of the paralysis. Only after an accurate diagnosis, can restoration of laryngeal function be addressed. Peripheral lesions injuring the vagus nerve or its branches are responsible for 90% of all vocal cord paralysis. Etiologies include neoplasms, surgical iatrogenic injury, and blunt and penetrating trauma in the head, neck, and thorax. Thyroid surgery has historically been accountable for almost a third of reported unilateral vocal cord paralyses. However, recent review has demonstrated a dramatic reduction in this incidence to less than 5%. Numerous treatment options exist for patients with vocal cord paralysis. These treatments can drastically reduce the social and economic disability incurred by these patients.