From August 1994 to September 1995, 12 silastic medialization procedures were performed for the treatment of vocal fold palsy. The causes included tuberculous fibrosis, carcinoma of the bronchus, post-oesophagectomy for carcinoma of the oesophagus and idiopathy. Early operation was performed in cases due to malignant conditions to relieve symptoms. In those with benign conditions, operation was performed if conservative treatment failed to control the symptoms in six months. The efficacy of silastic medialization for the treatment of dysphonia was evaluated by both subjective and objective voice assessment. The results indicate that the procedure is effective in the relief of dysphonia in unilateral vocal fold palsy. Only one patient in the study required a revision operation due to unsatisfactory voice quality. The procedure has the advantages of being tunable, reversible, and suitable for old and debilitated patients. The long term benefits of the procedure require further study.