Background: Bilateral vocal cord palsy (BVCP) continues to be a challenge for laryngologists. The cause varies from idiopathic to trauma. At present, there are many static surgical treatments available for BVCP, which improve airway at the expense of voice. More than 75% of nerve fibers goes to adductors. Bilateral adductor involvement is rare in BVCP. For improving the airway without compromising the voice a dynamic procedure is needed. Two such procedures at experimental stages are total selective reinnervation and posterior crico arytenoid (PCA) pacemaker. Here, we are analyzing our experience with eight such cases of total selective reinnervation. Aim: To assess the efficacy of total selective reinnervation in cases of BVCP. Objectives: (1) To assess the improvement in airway post total selective reinnervation; (2) To assess the improvement in voice post total selective reinnervation; (3) To assess the involvement of swallowing function in total selective reinnervation. Methodology: This is a prospective study of 8 cases of BVCP who had undergone total selective reinnervation during a period of 9 years. Among the eight cases, two cases had idiopathic BVCP and six cases were post total thyroidectomy. All patients had a minimum follow-up period of 12 months except the last case which was in 7th postoperative month. Patient selection: all cases were seen within 2 years of their complaint except the child with congenital bilateral vocal cord palsy which was done at 4 years. Examination under anesthesia was done in all cases to rule out cricoarytenoid joint fixity. Electromyography (EMG) was not done. Pre-op assessment of quality of voice in each of these patients was done with Voice Handicap Index (VHI-10). Glottic space assessment was done with dyspnoea index score and flexible endoscopy. None of the patients had swallowing dysfunction at presentation. A repeat assessment was done at 6 and 12 months post-op and the results were compared. Results: In the immediate post-op period, all the patient had worsened voice quality. However, voice improved by 4 months and by 12 months all patients had better voice and lower VHI. Regarding airway: six patients were decannulated in 2 weeks, one patient was decannulated after 4 months and the youngest one after 1 year. By 6 months all patients had improved their dyspnea index by 1. However, between 8 and 12 months four patients had worsening dyspnea index requiring static procedures. Out of the four patients who did not require static procedures, one has completed only 6 months. The immediate swallowing dysfunction following the procedure improved within a period of 2 weeks. Conclusion: Total selective reinnervation improved the voice in all cases and it did not have any adverse effect on swallowing; however, the long-term effect in improving the airway was only in 50% of patients. The best results were obtained in younger patients. This is in sharp contrast with nonselective reinnervation for unilateral vocal cord palsy, whose success rate is as high as as 95%. This suggests that total selective reinnervation is to be taken up only in selected patients and that too only after detailed discussion about the final outcome and possible need for further surgical procedures.