One hundred eighty-one patients with unilateral or bilateral vocal cord paralysis unrelated to laryngeal carcinoma or its therapy were studied. The orderly diagnostic profile used to delineate cause of the paralysis includes CBC, VDRL blood sugar profile, latex fixation and serum sampling for toxic heavy metals. The radiologic and endoscopic evaluation is done to completion unless contraindicated, to assess aspiration as well as to observe laryngopharyngeal structures which may cause the paralysis. This evaluative profile defined the etiology of cord paralysis in 80 percent of patients, despite exclusion of viral disease as a cause subsequent to upper respiratory infection. Blunt trauma and previous neck surgery each were responsible for 23 percent of the cases. Fifty-four patients had bilateral paralysis of which 22 were post thyroidectomy. Surgical repair for cord paralysis was symptomatic, and included 28 successful teflon injected cords. Recurrent laryngeal nerve decompression was successful in four of five operations and arytenoidectomy was performed in 39 patients.