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Purpose: In this study, a bidirectional mendelian randomization was applied to evaluate the association of smoking and alcohol consumption with 11 otolaryngological diseases. Methods: A total of 85,22,34 and 7 single nucleotide polymorphisms were used as instrumental variables for smoking initiation, cigarettes per day, alcoholic drinks per week and alcohol consumption, respectively. Genetic associations with 11 common otolaryngological diseases were obtained from the UK Biobank and FinnGen dataset. IVW, weighted median, MR-Egger, MR-PRESSO and leave-one-out method were used in this analysis. Results: Smoking initiation increased the risk of vocal cord and larynx diseases (OR 1.002; 95% CI 1.001–1.004; P = 4 × 10–4), head and neck cancer (OR 1.001; 95% CI 0.999–1.003; P = 0.027), thyroid cancer (OR 1.538; 95% CI 1.006–2.351; P = 0.047) and sleep apnoea (OR 1.286; 95% CI 1.099–1.506; P = 0.002). Cigarettes per day was associated with chronic sinusitis (OR 1.152; 95% CI 1.002–1.324; P = 0.046), chronic rhinitis and pharyngitis (OR 1.200; 95% CI 1.033–1.393; P = 0.017), vocal cord and larynx diseases (OR 1.001; 95% CI 0.999–1.002; P = 0.021) and head and neck cancer (OR 1.001; 95% CI 0.999–1.003; P = 0.017). Alcoholic drinks per week only was significantly associated with the risk of head and neck cancer (OR 1.003; 95% CI 1.001–1.006; P = 0.014). However, there was no evidence to support that genetically predicted alcohol consumption increased the risk of otolaryngological diseases. Reverse MR also did not find outcomes effect on exposures. Conclusion: This study shows that smoking and heavy alcohol consumption promote the occurrence of some otolaryngological diseases indicating that lifestyle modification might be beneficial in preventing otolaryngological diseases. [ABSTRACT FROM AUTHOR]