For a study, the researchers determined risk factors for postoperative otolaryngologic complications among patients who underwent primary and revision anterior cervical discectomy and fusion (ACDF). Electronic medical records of adults who underwent ACDF with predicted difficult surgical site exposure performed by 2-surgeon between 2008 and 2018 was reviewed. In total, 718 adults with an average age of 55.8 years and 45% female sex were taken under consideration. About 175 patients (27%) underwent revision ACDF; ACDF status was unidentifiable for 74 patients. Nearly 79 cases (12%) involved one spinal level. New postoperative otolaryngologic symptoms among those who underwent primary and revision ACDF were 12.6% and 10.9%, respectively. The researchers found no evidence of a relation between postoperative otolaryngologic symptoms and revision ACDF (OR, 0.84 [95% CI, 0.48–1.49]; P=0.55), but the evidence was found of a relationship with prior thyroidectomy (aOR, 3.8 [95% CI, 1.53–8.94], P=0.0003). Significant evidence was found of increased odds for new postoperative dysphagia with an increasing number of surgical levels (AOR, 1.5 [95% CI, 1.09–2.07]; P=0.01). Before thyroidectomy and number of spinal levels addressed during ACDF was identified as a risk factor for postoperative otolaryngologic complications, including dysphagia. Revision ACDF was not related to increased odds of postoperative otolaryngologic symptoms or dysphagia.