Most patients with bilateral vocal cord paralysis have a fairly satisfactory voice, but their airway is usually inadequate for day-to-day exertion. In some patients, the airway may be inadequate for even quiet respiration and an indwelling tracheotomy is required. Solution to this problem has involved the following techniques: tracheotomy, lateralization of the vocal cord by either endoscopic or external routes, or vocal cord reinnervation by the nerve-muscle transposition technique. Endoscopic laser arytenoidectomy has been mentioned in the literature. However, the actual technique as well as the attendant morbidity associated with this procedure has not been highlighted. Four patients with bilateral vocal cord paralysis of the larynx have been treated by endoscopic laser arytenoidectomy at Northwestern University Medical School. The technique, problems, and results are discussed.