Objective: The objective of our study is to analyze the various indications of emergency tracheostomy at Civil Hospital Karachi and Liaquat University Hospital Hyderabad, Pakistan. Study Design: Descriptive, Cross sectional study. Place & Duration of Study: This study was conducted at the department of Otorhinolaryngology-Head & Neck Surgery, Dow University of Health Sciences, Civil Hospital Karachi and Liaquat University Hospital Hyderabad from May 2007 to April 2010. Methodology: All patients admitted to emergency department, having a compromised upper airway as well as patients in the other departments of the same hospitals developing an upper respiratory tract obstruction/respiratory insufficiency were selected for this study. A quick assessment of the degree of upper airway obstruction was made from the patient's dyspnea, stridor, cyanosis & suprasternal and intercostal recession and patients were selected for emergency tracheostomy. All tracheostomies were done by open surgical technique under local anaesthesia in Emergency Operation Theater. Statistical analysis was carried out using SPSS 16. Results: Out of 175 patients, 132(75.5%) were male and 43 (24.5%) were female. Mean age was 40.45 years and Std. deviation ±15.063, ranging from 07 to 80 years. The most common indication for emergency tracheostomy in our study was found maxillo-facial trauma (58.3%) followed by laryngeal & hypopharyngeal malignancies (23%), tetanus (8.6%), corrosive ingestion (7.4%), subglottic stenosis (2.2%) and diphtheria (0.5%). Conclusion: Until the last two decades, the most common indication for emergency tracheostomy was upper respiratory infection such as diphtheria, epiglottitis but with the advent of new antibiotics and effective vaccination programs, these indications were reduced and rarely seen now a days. The most common recent indications are trauma (road traffic accidents) followed by malignancies of larynx &hypopharynx.