OBJECTIVE To obtain baseline data on the most common surgical emergencies in pediatric otolaryngology in Saudi Arabia. METHODS This report is a retrospective study of all children presenting to the pediatric otolaryngology emergency service at King Abdulaziz University Hospital in Riyadh, Kingdom of Saudi Arabia. Between January 2001 to January 2006 data were carefully collected and then analyzed for patients requiring emergent surgical intervention by the pediatric otolaryngology service. RESULTS A total of 15,850 children presented to our pediatric otolaryngology emergency service. Surgical intervention was indicated in 183 children (1.2%). The larynx/head & neck was the most common site involved. Foreign body related emergencies were the most common presentation requiring surgical interventions (42%). The aero-digestive tract was the most common site for foreign body retrieval (54%). CONCLUSIONS Pediatric patients have always constituted a significant portion of the general otolaryngology service. Most pediatric otolaryngology emergencies are relatively benign. Aero-digestive tract foreign bodies are the most common indication for surgical intervention in ped iatric otolaryngology.