Aim: To demonstrate the functional voice outcomes following external medialization thyroplasty using autologous cartilage from the nasal septum. Materials and methods: The study included four patients (three males and one female) who presented to the ENT outpatient department diagnosed with unilateral vocal fold paralysis. Medialization thyroplasty type I was performed for all the patients using autologous nasal septal cartilage with the patients under local anesthesia. Results: All four patients showed significant improvement in the form of glottis closure on laryngoscopic examination. Complete glottis closure was achieved in three patients while one patient had a small posterior glottis gap. The maximum phonation duration improved significantly in three patients, i.e., average 13.33 seconds; while one patient with the small posterior glottis gap showed minor improvement, i.e., 7.1 seconds. However, the complaint of aspiration of liquids was relieved in all the four patients. Conclusion: External medialization thyroplasty using an autologous nasal septal cartilage graft is considered safe and efficient phonosurgical procedure and provides proper positional adjustment of the paralyzed vocal fold with significant improvement in the subjective and objective functional voice outcomes.