To study the surgical effect of endoscopic bilateral posterior vocal cord amputation for upper airway obstruction caused by bilateral vocal cord paralysis. Methods From January 2017 ~ October 2021, 83 patients with upper airway obstruction caused by bilateral vocal cord paralysis were included in this study. The patients were divided into observation group of 41 cases and control group of 42 cases according to computer random number table. The control group received traditional surgical treatment, and the observation group received bilateral posterior vocal cord resection under endoscope. The two groups were analyzed the difference in terms of one-time successful tracheal cannula removal rate, success rate of airway reconstruction, changes in swallowing function before and after surgery, postoperative complications, postoperative pronunciation satisfaction rate and other aspects. In addition, Logistic analysis was used to determine the influencing factors of poor postoperative prognosis in patients with upper airway obstruction caused by bilateral vocal cord paralysis. Results The successful rate of tracheal cannula removal and airway reconstruction in observation group were 75.61% and 90.24%, which were significantly higher than those in control group of 53.66% and 69.05% (all P＜0.05). After surgery, the Pearson scores of the observation group and the control group were (0.32±0.02) points and (0.86±0.07) points, which were significantly lower than the (2.12±0.33) points and (2.13±0.32) points before surgery, and the observation group was significantly lower than control group (all P＜0.05). The evaluation of postoperative pronunciation satisfaction rate in observation group was higher than control group (P＜0.05). Logistic analysis showed that failure to perform bilateral posterior vocal cord resection under endoscopy, age and postoperative complications were all risk factors for poor postoperative prognosis of patients with upper airway obstruction caused by bilateral vocal cord paralysis (all P＜0.05). Conclusion Bilateral endoscopic posterior vocal cord amputation has significant surgical effect on upper airway obstruction caused by bilateral vocal cord paralysis, and is beneficial to promote the recovery of swallowing function and pronunciation of patients, which is worthy of clinical application