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This study involves a series of 10 patients who developed paralyzed vocal folds, years, and often decades, after receiving radiation treatment for a variety of treatments. A group of patients who developed paralysis more than 20 years after treatment for Hodgkin’s lymphoma are particularly noteworthy. The discussion covers likely mechanisms of the development of nerve damage after radiation. No paralyses recovered spontaneously, and four were treated adequately with injection augmentation.