To compare the functional results between posterior cordotomy, cordoplasty and external procedure in managing bilateral vocal cord paralysis in one of the largest published study group. Retrospective and comparative study. 54 patients with bilateral vocal cord paralysis who underwent posterior cordotomy (Group-I), cordoplasty (Group-II) and external procedure (Group-III) from 2001 to 2013 were compared for functional outcomes. Successful decannulation was achieved more in Group-I and II than in Group-III. Voice outcome was better in Group-II patients compared to other groups. Outcomes of cordoplasty was better than posterior cordotomy and external procedures, with acceptable airway and good quality of voice. Posterior cordotomy is preferred in patients without tracheostomy and in pediatric patients. In patients with tracheostomy or who accept temporary tracheostomy, a cordoplasty is preferred for favorable voice. External procedure is preferred for patients not fit for general anesthesia.