Aim: To find out the vocal outcome of conservative management and temporary medialization in unilateral vocal cord palsy (UVCP) and their effectiveness in reducing the need for permanent medialization. Materials and methods:Thirty adult patients with UVCP, without structural vocal cord lesion or laryngeal malignancy were initially treated conservatively, and those without adequate response at 3 months were treated with temporary medialization. They were followed up for 6 months. Pre-and posttreatment voice was compared using grade, roughness, breathiness, asthenia, strain (GRBAS) scale, Voice Handicap Index (VHI), and maximum phonation time (MPT). Results:The results show 40% cases were idiopathic, whereas 33.33% had iatrogenic cause, majority, following thyroidectomy; 66.67% responded well to the conservative management. Ten patients (33.33%) did not show satisfactory improvement in the first 3 months and were treated with temporary medialization. Both the groups were comparable at the first visit. At 6 months, the improvement in all parameters was significantly more in the temporary medialization group than the conservative management group compared with their values at 3 months. Two of the 10 patients treated with injection laryngoplasty were considered for permanent medialization. The final outcome was similar in both the groups. Conclusion:Conservative management of UVCP is the standard of care. Injection laryngoplasty at 3 months achieves better voice outcome in those not fully improved by conservative management. Medialization thyroplasty should be suggested in patients failing to show the desired improvement after injection laryngoplasty.Clinical significance: The study guides in the management of UVCP, in terms of its likely cause and approach to treatment.