Vocal fold motion abnormalities may be present in a variety of patients in the ICU and maybe the underlying cause for hoarseness, dyspnea, and respiratory distress. They may also contribute to post-extubation stridor, wheezing, and respiratory failure. Distinguishing vocal fold motion abnormalities from other causes of dyspnea may be helpful in the management of patients in the ICU. Gold standard diagnosis is obtained by indirect flexible laryngoscopy (IFL), which may be associated with patient discomfort and may not be applicable in patients in severe distress. Transcutaneous Laryngeal Ultrasonography may allow diagnosis of certain vocal fold motion abnormalities, noninvasively with minimum discomfort to the patient. In this chapter, we review the technical aspects of diagnosing these abnormalities with ultrasound and discuss the evidence for the clinical utility of Transcutaneous Laryngeal Ultrasonography and the use of this modality for the management of patients.