INTRODUCTION Paralysis of one or both vocal folds may impair the important physiologic functions of the larynx: breathing, swallowing and voicing. Individuals with laryngeal hemiparalysis typically complain of a broad range of symptoms reflecting variable degrees of glottic insufficiency. The most prominent of these are breathy dysphonia and dysphagia, particularly to liquids. Breathlessness while speaking and breathlessness during physical exertion may also be present. When both vocal folds are affected by the paralytic process, patients generally complain of symptoms of glottic obstruction such as stridor and dyspnea. This distinction in symptoms between unilateral and bilateral paralysis reflects the contrasting valving tasks of the larynx: glottic opening for respiration and glottic closure for airway protection, thoracic stabilization during effortful activity, and phonation.