Decannulating a patient on a tracheostomy is a procedure that has to be dealt with vigilantly. This study evaluated both external and telescopic/bronchoscopic findings at the peristomal level of subjects being considered for decannulation. The patients did not undergo any intervention after above observations and before attempting decannulation. Thereafter peristomal findings and their contribution towards failure to decannulate were correlated. Thirty subjects were studied prospectively, of whom 21 (70 %) demonstrated peristomal complications including granulation tissue, ulceration, mucopurulent discharge, suprastomal granulations, suprastomal collapse and suprastomal flap. Complications were more common in the younger age group (p = 0.007) as well as in tracheostomies of longer duration with mean duration [20 months (p = 0.045). However there was no statistically significant correlation between the success of decannulation and various peristomal findings. Therefore the success of decannulation in a particular case cannot always be correctly predicted by peristomal assessment.