Background:
Postoperative laryngopharyngeal discomfort (POLPD) is a common yet undermanaged complication after tracheal extubation. While mechanical pressure from the endotracheal tube is implicated, quantitative data linking tube-tissue contact pressure to POLPD are lacking. This study aimed to establish a quantitative relationship between tracheal tube contact pressure and POLPD, while identifying bedside applicable, simplified clinical risk indicators.

Methods:
In this prospective observational study, 89 patients undergoing elective surgery (≥ 2 hours) were enrolled. We adapted a T-scan III occlusal analysis system to measure tracheal tube pressure distribution at four intraoperative timepoints. POLPD was defined as a composite endpoint including severe pharyngalgia (NRS ≥ 4), profound dysphagia (bedside water swallow test ≥ 4), or prominent tongue edema.

Results:
POLPD incidence was 39.1%. Multivariate analysis identified two independent risk profiles: female with narrow pharyngeal cavity (OR 3.26, 95% CI: 2.1–4.87, P < 0.001) and prone position with non-neutral O–C2 angle (OR 1.94, 95% CI: 1.34–2.81, P < 0.001). The POLPD group had significantly higher tracheal tube pressures. A pressure-overload index independently predicted POLPD (OR 1.17, 95% CI: 1.01–1.37, P = 0.041), demonstrating a dose-response relationship.

Conclusions:
This study provides quantitative evidence linking tracheal tube contact pressure to POLPD. Two simplified clinical risk indicators were identified: “lady overweight, chin looks short, snore at night, airway’s tight” (female with narrow pharyngeal cavity) and “neck bent too far” (prone with non-neutral O–C2 angle). Real-time pressure monitoring is a promising target for future airway protection.