Vocal Tract Fat Distribution and Patient Tolerance to Transnasal Office‐Based Laryngeal Surgery

OBJECTIVE: To analyze the correlation between vocal tract fat volume and patient tolerance to office-based laryngeal surgery using the transnasal approach. METHODS: The medical records and video recordings of all patients who underwent office-based laryngeal surgery (OBLS) between April 2024 and January 2026 were reviewed. Demographic data included age, gender, body mass index (BMI), history of smoking, history of reflux disease, allergy, voice diagnosis, and type of OBLS. Three fat compartments were analyzed: (1) parapharyngeal fat volume at the palatal level, (2) parapharyngeal fat at the glossal level, and (3) the pre-epiglottic adipose tissue. Patient tolerance was evaluated using the IOWA Satisfaction with Anesthesia Scale and a Visual Analog Scale (VAS). RESULTS: Forty patients were included in the study. The mean IOWA score of the total group was 2.55 ± 0.68, and the mean VAS tolerance score was 8.70 ± 1.65. Linear regression analysis accounting for potential confounding factors showed a moderate, negative, statistically significant correlation between the volume of parapharyngeal fat at the level of the palate and IOWA scale score (adjusted coefficient β = -0.567, p = 0.049). There was also a mild, negative, non-significant correlation between the volume of parapharyngeal fat at the level of the palate and VAS scores (adjusted coefficient β = -0.251, p = 0.211). CONCLUSION: An increase in parapharyngeal fat volume at the level of the palate was associated with a decrease in IOWA scale score, suggesting reduced tolerance to OBLS. A study with a larger sample size is needed to draw stronger conclusions.