Voice fold paralysis (VFP) is a disease caused by various factors that impair the neural pathways controlling the muscles within the larynx, leading to vocal cord movement disorders. The current clinical assessment methods mainly include laryngoscopy, voice acoustic assessment, CT, and laryngeal electromyography (LEMG). Among them, LEMG is the gold standard for diagnosing VFP. By collecting electrophysiological recordings from the laryngeal muscles and nerves, it is possible to assess the nature and extent of the damage, enabling precise, qualitative, and quantitative diagnosis and prognosis evaluation. However, the standards for the application of clinical LEMG are not yet uniform. This paper reviews the pathophysiological mechanism of VFP and the research progress of LEMG in the diagnosis of VFP. The aim is to improve the diagnostic accuracy of otolaryngologists for VFP.