Background: Bilateral vocal cord paralysis (BVCP) is the second common cause of stridor in children. Most BVCP cases are managed by tracheostomy. Cases that show no spontaneous recovery after about two years require some sort of lateralization procedure such as cordectomy, arytenoidectomy. Objective: Our study aimed at reviewing BVCP cases, its etiology, and the type and number of interventions needed for decanulation. Methods: Retrospective review. Results: Twenty five patients were identified in the 10 year period to have BVCP at king Abdulaziz University Hospital. Thirteen (52%) were iatrogenic causes. Six (24%) were benign tumors. Four (16%) were congenital. Two (8%) were neurological causes. One (4%) was malignant tumor. One (4%) was unknown. All patients underwent cordectomy for the right vocal cord using CO 2 laser at 5 watts. Among them, eighteen (72%) were decanulated after laser cordectomy. Seven (28%) were still on tracheostomy. Of the 25 patients, eight patients had only one intervention. Nine patients had two. Five patients had three interventions. Two patients had four interventions. One patient had five interventions. Conclusion: Unilateral laser cordectomy offered a quick and effective surgical intervention for treatment of bilateral vocal cord paralysis. It requires special equipment and expertise. Decanulation success is multifactorial and does not correlate with surgery alone.