Background: Prolonged tracheostomy bypasses the upper airways leading to absence or reduction of nasal airflow. This altered nasal physiology not only impairs olfaction but also may cause mucociliary dysfunction and consequent nasal crusting and rhinosinusitis. Objective: To objectively evaluate the extent of nasal mucociliary impairment in patients with prolonged duration of tracheostomy. Design and Setting: This is a prospective case-control study done in a tertiary care center wherein the nasal mucocilary function was assessed by saccharin test in patients who were tracheostomized for a period of more than 4 weeks and the saccharin transit time (time taken to appreciate the sweet taste after endoscopic insertion of saccharin pellet on anterior end of inferior turbinate) was compared by the same test in age and sex matched healthy individuals. Main outcome measures: Clinical data, indication of tracheostomy and duration of tracheostomy were assessed for their impact on the nasal mucociliary clearance using saccharin transit time in the two groups which was then statistically analyzed using student t-test. Results: Mean saccharin transit time in 30 patients with prolonged tracheostomy was 934.97 seconds with a standard deviation of 75.95 seconds whereas in 30 controls, the meantime was 447.4 seconds with a standard deviation of 63.22 seconds, which was statistically significant (p<0.001) Conclusion: Prolonged duration of tracheostomy leads to impaired nasal mucociliary clearance, which in turn could cause chronic rhinosinusitis.