Objective: The aim of this study is to show another possible cause of oropharyngeal fibrosis causing breathing difficulty and dysphagia, and to demonstrate the possible effects of Khat chewing on the pharynx and larynx. Methods: This cross-sectional study included all patients using Khat referred to Phoniatric Unit, Oto-Rhino-Laryngology department[removed for blind peer review] due to different reasons during the period of March-2017 and September-2019. A nine-question self-administered structured questionnaire was developed to covers all the socio-demographic factors in addition to Khat chewing habits. Full endoscopic evaluation was made and biopsies were obtained whenever possible. Patients were grouped into two groups; one using hot Khat (insecticide-irrigated) and the other using cold Khat (not insecticide-irrigated). Results: The overall sample was 120 cases; 22 are using hot Khat and 98 cold Khat. Both groups are comparable with regard age, gender, smoking, duration of using Khat as well as its frequency. Reasons for referral for clinic were different between groups (p<0.001). Oropharyngeal stenotic lesions are (p< 0.0001) more frequent in the hot Khat group (77.3%) than in the cold Khat group (0%). In addition, chronic non-specific inflammation is significantly (p<0.0001) more frequent in the hot Khat group (68.2%) than in the cold Khat group (0%). Conclusion: The relation between Khat chewing and oropharyngeal fibrosis can be proposed with strong relation to the use of pesticides. Further studies are recommended to confirm this relation. Succinct Key points: Khat chewing, oropharyngeal fibrosis, dysphagia, nasal obstruction, Yamen