Nasogastric tubes were the strongest link to hoarseness needing ENT review

Design

Retrospective single-centre cohort, 2015–2025

Population

676,641 general anaesthetics; 958 patients referred with hoarseness

Primary outcome

Hoarseness referred for ENT consultation

Effect

Incidence 0.142%; nasogastric tube OR 2.34 (1.63–3.38); TOE OR 1.84 (1.15–3.02)

This single-centre study, published in Anesthesia & Analgesia on 21 September, looked back over 676,641 general anaesthetics between 2015 and 2025. Hoarseness serious enough for ENT referral occurred in 958 patients, about 1.4 per 1,000.

Within the referred group, nasogastric tube placement was most strongly associated with hoarseness rather than other throat complaints (OR 2.34), followed by transoesophageal echocardiography (OR 1.84). More severe vocal fold injury was associated with nasogastric tubes, TOE, longer surgery, double-lumen tubes and female sex. Referral six or more days after symptoms began was associated with slower recovery.

The practical points are to place nasogastric tubes gently and only when needed, and to refer persistent hoarseness early rather than waiting.

• Place nasogastric tubes only when needed, and gently, avoiding repeated passes.
• Ask about voice change at postoperative review, especially after TOE or double-lumen tubes.
• Refer hoarseness persisting beyond a few days to ENT early.
• Document airway devices and tube placement for any later assessment.

Why it matters

Delay in referral, not just the injury, was linked to slower voice recovery.

Don't overread it

Comparisons were within referred patients only, not against all anaesthetised patients.

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