Background: Sites of head and neck are associated with chewing, swallowing and speaking. As for treatment of head and neck cancer (HNC), we have to consider organ preservation as well as clinical outcomes. Although non-surgical treatments have been preferred in recent years, complications after treatment have been a concern. The aim of this study was to evaluate the late effects in a cohort of HNC survivors in Utah compared to a matched cohort of cancer free individuals. Methods: Up to 5 cancer free individuals were matched to each HNC survivor on birth year, sex, birth state, and follow up time. Electronic medical records and statewide ambulatory and inpatient surgery data were used to identify late effects over two time periods: 1-5 and 5-10 years after cancer diagnosis. Cox proportional hazards models were used to estimate the risks of late effects. We adjusted for matching factors, race and number of hospital visit. Results: In this study, 2,432 HNC survivors and 12,149 matched controls were enrolled. More than 80% cases had loco-regional disease and a histological type of squamous cell carcinoma. Hazard ratio (HR) for second primary HNC was notably increased among HNC survivors for both 1-5 years (HR: 1498.46; 95% confidence interval (CI), 158.58-14159.69) and 5-10 years (HR: 1509.62; 95% CI, 147.94-15404.15) post cancer diagnosis. And, HRs for respiratory disease, including respiratory system, lung cancer and pneumoniae, were also increased among HNC survivors for both 1-5 years and 5-10 years post cancer diagnosis. As for hearing loss, HNC survivors had a increased HR for 1-5 years post cancer diagnosis (HR: 5.90; 95% CI, 2.67-13.01) and this association was consistent for 5-10 years post cancer diagnosis (HR: 5.01; 95% CI, 2.06-12.18). Conclusions: In this study, we found HNC survivors have notable associations with second primary HNC, smoking related respiratory disease, and hearing loss which might be associated with chemotherapy when compared to cancer free subjects.