Tracheotomy is the term used to refer to the creation of a surgical opening into the trachea. Tracheostomy is used when a formal opening or stoma is made. To identify patients requiring Tracheostomy, either on emergency or elective basis. This prospective comparative study was carried out in a tertiary care centre, INSTITUTE OF OTORHINOLARYNGOLOGY & HEAD–NECK SURGERY, IPGME&R, KOLKATA, on ICU admitted patients who underwent emergency as well as elective tracheostomy in the period of OCTOBER 2018 to SEPTEMBER 2019. Tracheostomies were performed more often in men (78%) than in Women (22%) in the ratio of 3.5:1. Both elective and emergency tracheostomy was performed each having 25 in number. Various indications of tracheostomy are laryngeal carcinoma (40%), CVA (12%), hypopharyngeal carcinoma (10%), head injury (10%), post–op intra cerebral SOL (10%), thyroid malignancy (4%), mandibular malignancy (4%), papillomatosis (4%), and GB syndrome (4%).Tracheostomy can be done safely under local anaesthesia. Various complications were the haemorrhage (6%), surgical emphysema (6%), tubal displacement (4%), tubal blockage (2%), stomal stenosis (2%), and wound infections (2%). Tracheotomy alters the basic physiology of the inspired air from filtered, warm and humidified to dry cold air coming into direct contact with the trachea. This alterations dry up the tracheal and pulmonary secretions and interferes with ciliary capacity to move the mucous blankets, and thus causes production of thick, tenacious mucous scabs & crusts. If the situation is not controlled the scab will increase in size with the result that they are difficult or impossible to cough out or even removed by suction.