Objective: To determine postoperative pain in different types of ear, nose, and throat (ENT) surgery and their psychological preoperative predictors. Design: Prospective cohort study. Setting: Academic hospital. Patients: A total of 217 patients undergoing ENT surgery. Interventions: All ENT, neck, and salivary gland surgery. Main Outcome Measures: Postoperative pain and predictors for postoperative pain. Results: Fifty percent of the patients undergoing surgery on the oral, pharyngeal, and laryngeal region and on the neck and salivary gland region had a visual analog scale score higher than 40 mm on day 1. In the patients who underwent oropharyngeal region operations the VAS score remained high on all 4 days. A VAS pain score higher than 40 mm was found in less than 30% of patients after endoscopic procedures and less than 20% after ear and nose surgery. After bivariate analysis, 6 variables-age, sex, preoperative pain, expected pain, short-term fear, and pain catastrophizing-had a predictive value. Multivariate analysis showed only preoperative pain, pain catastrophizing, and anatomical site of operation as independent predictors. Conclusions: Differences exist in the prevalence of unacceptable postoperative pain between ENT operations performed on different anatomical sites. A limited set of variables can be used to predict the occurrence of unacceptable postoperative pain after ENT surgery.