Purpose <p>Postoperative sore throat (POST) is a common clinical problem after thyroid surgery. Although literature describes it as a minor adverse effect, it may be troublesome and can make the patient feel uncomfortable. Drugs like nebulised budesonide and ketamine offers significant benefits with variable results in reducing the incidence and severity of postoperative sore throat. This study compares the effect of ketamine and budesonide nebulisation on reducing the incidence and severity of postoperative sore throat in adult patients undergoing elective thyroidectomy.</p> Methods <p>A prospective comparative study was conducted in 120 patients (ASA I and II), aged 20–60 years undergoing elective thyroidectomy in a duration ranging from 1 to 3&#xa0;h. Patients were divided into two equal groups, one receiving nebulised ketamine and the other receiving nebulised budesonide, 10&#xa0;min before induction of general anaesthesia. Postoperative sore throat was graded using a four-point scale (0–3) as described by Harding and McVey, based on patient-reported severity. Statistical comparison was done using student’s ‘t’ test for continuous variables and chi-square test for qualitative variables using IBM SPSS version 22.</p> Results <p>The overall incidence of POST was less in budesonide group (33%) when compared to 70% in ketamine group. The incidence of postoperative sore throat was significantly less in budesonide group at 0, 2&#xa0;h and 4&#xa0;h after extubation. No correlation of age, gender and ASA grading with post operative sore throat was seen in the present study.</p> Conclusion <p>Administration of budesonide nebulisation prior to induction of general anaesthesia significantly prevent and reduce the occurrence of postoperative sore throat when compared to ketamine nebulisation in patients undergoing thyroidectomy.</p>