Is my post-intubation sore throat something to worry about?
Reviewed by Thomas William Binnersley

Laryngeal injury (LI) is a rare but serious adverse outcome of endotracheal intubation, thought to arise from compression-related trauma to the laryngeal nerves and resulting neuropraxia. Patients typically present with transient postoperative dysphonia which usually resolves within a matter of days, but a small minority may develop persistent symptoms due to vocal cord dysfunction. This retrospective study investigates the incidence, management and outcomes of postoperative LI, excluding patients undergoing thyroid, parathyroid, cardiothoracic or anterior cervical spine surgery which carry inherently higher risks of direct laryngeal nerve injury. Among ~268,000 patients undergoing ~455,000 general anaesthetics between 2018 and 2024, 30 developed LI severe enough to warrant laryngology referral; an incidence of 6.6 per 100,000. Whilst this sounds reassuringly small, a mere anaesthetic complication footnote, it likely underrepresents the true population incidence, as most milder cases will never reach ENT clinic, let alone a quaternary laryngology service, and higher-risk surgeries were excluded. Of these 30 patients, 19 had a defined vocal cord movement abnormality, mostly unilateral immobility or hypomobility, whilst 11 had no structural abnormality. All patients reported dysphonia, 4 had dysphagia and 7 had oropharyngeal pain. Rather strikingly, at median follow-up of 12 months, only two thirds of patients showed even partial improvement, with none achieving full resolution. Management was conservative (voice or physiotherapy) in 14 patients, whilst 12 received hyaluronic acid injection laryngoplasty, 8 of whom required repeat injections. The authors discuss possible risk factors implicating intubation technique rather than duration: direct laryngoscopy, improper use of stiff intubating stylets during video laryngoscopy, adjunct manoeuvres including cricoid pressure, and extrinsic instrumental pressure. This highlights the importance of a skilled proceduralist in higher-risk patients. The authors rightly advocate for a prompt ENT referral for persistent postoperative dysphonia with the same urgency as post-thyroidectomy dysphonia to spare patients from a diminishing window for evaluation and recovery.

Laryngeal Injuries Following General Endotracheal Anesthesia: A Case Series.
Zodi A, Weingarten TN, Ryll MJ, et al.
ANN OTOL RHINOL LARYNGOL
2026;17:34894261457485 [ePub ahead of print].