Vocal cord paralysis results from dysfunction of the recurrent laryngeal nerve (a branch of the vagus nerve, CN X), which innervates all intrinsic laryngeal muscles except the cricothyroid. Unilateral paralysis (most common) causes hoarseness, breathy voice, and aspiration risk, as the affected cord remains fixed in a paramedian position, preventing complete glottic closure during phonation and swallowing. Bilateral paralysis causes airway obstruction (both cords fixed near midline) with stridor, requiring potential emergent airway management. The left recurrent laryngeal nerve is more commonly affected because of its longer course: it loops under the aortic arch and ascends in the tracheoesophageal groove, making it vulnerable to injury from thyroid surgery, neck surgery, cardiothoracic procedures, intubation trauma, mediastinal masses, and aortic aneurysm. Iatrogenic injury during thyroidectomy is the most common cause. The nurse assesses voice quality (hoarseness, breathiness), monitors for aspiration (cough with liquids, wet-gargling voice quality), implements aspiration precautions, coordinates speech-language pathology evaluation for swallowing assessment (modified barium swallow or FEES), positions the patient upright during meals, teaches chin-tuck and head-turn techniques to protect the airway, and monitors respiratory status in bilateral...