To the Editor, In a randomized controlled clinical trial, Park et al. showed that using triamcinolone acetonide paste over an endotracheal tube can reduce the incidence and severity of postoperative sore throat (POST) compared with using chlorhexidine gluconate jelly. Their findings have potential implications for prevention of POST, one of the common side effects associated with tracheal intubation. In our view, however, there are several aspects of this study that need to be clarified before adoption into routine practice. First, the article did not specify the manufacturers and ingredients of either the 0.1% chlorhexidine gluconate jelly or the 0.1% triamcinolone acetonide paste used in this study. It has been shown that chemical additives in some endotracheal tube lubricants, including local anesthetics, can irritate airway mucosa, potentially causing airway mucosal damage and ultimately leading to an increased incidence and severity of POST. The article did not clearly explain whether the 0.1% triamcinolone acetonide paste was a special preparation for airway mucosal use, hence, we suggest cautious interpretation of these findings. Second, POST is a result of airway mucosal injury with ensuing inflammation caused by the combined effects of airway instrumentation (i.e., laryngoscopy, endotracheal tube insertion, and airway suctioning) or the irritating effects of a foreign object (i.e., endotracheal tube, or cuff). The incidence and severity of POST are associated with many factors, including patient sex and age, tube size, surgical site, external laryngeal manipulation, intubating stylet during laryngoscopy and intubation, use of nitrous oxide during anesthesia, intracuff pressure during surgery, airway suctioning, duration of intubation, and postoperative analgesic protocols. To differentiate the effect of one factor related to POST, the other factors need to be standardized in the study design. The authors are to be commended for having tried to control for the majority of these factors. However, in this study, three factors do not appear to have been addressed adequately, i.e., use of the intubating stylet, external laryngeal manipulation, and oropharyngeal suctioning. It is logical to assume that use of the intubating stylet will predispose to airway trauma, especially when it is used blindly and with excessive force. Moreover, pharyngeal trauma caused by aggressive oropharyngeal suctioning has also been shown to be a contributing factor related to POST. In contrast, application of external laryngeal manipulation to facilitate visualization of the glottis during laryngoscopy may help to avoid damage around the glottis caused by forcible intubation, resulting in a decreased risk of laryngeal damage. Addressing these factors would further clarify the transparency of this study. Finally, one must consider the use of chlorhexidine gluconate jelly for comparison with triamcinolone acetonide paste. In previous studies, the authors have commented on the absence of a significant difference in the incidence of POST between unlubricated and lubricated tracheal tubes using chlorhexidine gluconate-containing jelly as a lubricant. Nevertheless, in these studies, we noted that the endotracheal tubes were actually lubricated with water-soluble jelly and Fu Shan Xue and He Ping Liu contributed equally to this work.