Objective: To highlight risk factors affecting outcomes of vocal cord paralysis (VCP) in patients with Arnold-Chiari malformations (ACM). Methods: A systematic review was conducted according to the 2020 PRISMA checklist. The authors comprehensively searched multiple databases from inception till August 2023 for both keywords and medical subject headings pertinent to ACM and VCP. Data from 33 studies were obtained by applying predetermined inclusion and exclusion criteria and quality assessment of the chosen articles. Meta-analysis using Chi-squared test and binary logistic regression was performed to determine the association between age and other variables. Results: The 33 studies included a total of 165 patients with a mean age of 15.31 months. The predominant type of Chiari malformation was type 2, observed in 120 cases. Bilateral vocal cord paralysis was confirmed in 103 patients while 12 patients had unilateral disease. The most common treatment modality was ventriculoperitoneal shunt placement in 108 patients (65.45%), followed by posterior fossa decompression surgery in 86 patients (52.12%). Regarding airway status, most patients were not intubated (65.45%), however more than one third of patients underwent tracheostomy (38.79%) following VCP. There was a significant association between the age of VCP onset and both recovery and survival in both the overall cohort and the ACM II cohort. Conclusion: Age at onset of VCP is a critical factor associated with both recovery and survival rates in pediatric patients, with younger age linked to partial symptom resolution and worse survival.