A difficult condition known as bilateral vocal fold immobility (BVFI) can be caused by a variety of conditions, such as vocal fold paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scarring. The majority of patients arrive with stridor and dyspnea, however breathy dysphonia can also occur. Precise diagnosis and suitable management planning can be achieved with the use of thorough history collection, laryngoscopic assessment under general anesthesia or awake condition, laryngeal EMG, and imaging tests using CT and/or MRI. One of the most prevalent etiologies of congenital neurological disorders in children is believed to be spontaneous recovery in over 50% of instances. Therefore, it is generally believed that before choosing to carry out any harmful treatment, one should observe the patient for more than six months while protecting the upper airway with a tracheostomy if necessary. Children with advanced posterior glottic stenosis may benefit from rib cartilage transplant laryngotracheal repair. Compared to children, adults are more likely to experience BVFI as a post-surgical consequence. Many static or dynamic techniques, such as vocal fold lateralization, endoscopic or open arytenoidectomy, arytenoid abduction and reinnervation, posterior cordotomy, and electrical laryngeal pacing, can be used; however, they must be carefully chosen based on the individual needs of each patient and the pathophysiology of BVFI.