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Abstract Background Post-extubation stridor indicates the presence of laryngeal edema. The documented occurrence of post-extubation airway blockage ranges from 4 to 37%. Aim To evaluate the effectiveness of sonar assessment of laryngeal air column width difference to predict post-extubation upper airway obstruction and its relation to cuff leak volume. Patients and methods This was an observational, descriptive cross-sectional study, conducted on 48 mechanically ventilated patients fulfilling weaning criteria at the ICU of Chest Department, Faculty of Medicine, Zagazig University, from July 2022 to March 2023. Results A statistically insignificant variance was observed among COPD, ILD, overlap (OSA-COPD), pneumonia, aspiration pneumonia, and PE regarding laryngeal air column width difference (LACWD), while a statistically significant variance was observed among COPD, ILD, overlap (OSA-COPD), pneumonia, aspiration pneumonia, and PE regarding CLV; there was no correlation among cuff leak volume and LACWD, and there were 40 patients (83.3%) who had no post-intubation upper air way obstruction and 8 patients (16.7%) had post-intubation upper airway obstruction: 4 of them (8.3%) had success weaning, and 4 (8.3%) had failed weaning; and at cutoff value 140 ml, cuff leak volume had sensitivity of 100% and specificity of 97.5% with significance for prediction of stridor, and at cutoff value 1.15 mm, LACWD had sensitivity of 87.5% and specificity of 67.5% with significance for prediction of stridor. Conclusion Cuff leak volume and ultrasound-guided LACWD effectively predict post-extubation upper airway obstruction, suggesting their integration into institutional extubation protocols.