Tracheotomy was performed on 181 of 351 patients with bulbar poliomyelitis. The essential indication for tracheotomy was secretional obstruction of the respiratory tract that could not be relieved by postural drainage and aspiration. Comparison of mortality rates in this series with those of previous series in which tracheotomy was not done in the presence of similar indications, suggests that the procedure may be life-saving in a considerable percentage of cases. Outside the respirator the tracheotomy can be done with or without the aid of the bronchoscope or endotracheal anesthesia tube. When done inside the opened respirator the Bennett flow-sensitive positive pressure machine should be used to supply oxygen to the patient while the respirator is not operating.