OBJECTIVE: To determine the frequency of un-safe chronic suppurative otitis media and its complications in patients with chronic discharging ear. METHODS: This study was carried out in the Department of Otorhinolaryngology, Civil Hospital Karachi, Sindh - Pakistan between January 2004 and June 2006. This study included 390 cases of chronic discharging ears attending out patient department. All were examined according to protocol, and relevant investigations were carried out. 107 cases underwent mastoid exploration and were observed for cholesteatoma, granulations, aural polyps and their complications. A structured questionnaire was designed to record all information which was later analyzed. RESULTS: Majority of patients was belonging to poor families. Female-male ratio was 1.2:1. Age range was between 6 months and 70 years. Most of the patients presented with discharging ears. Central perforation was seen in 89% cases. One hundred seven cases (27.5%) underwent mastoid exploration, in which cholesteatoma was found in 11.5% cases. Ossicular damage was the commonest complication in all cases having cholesteatoma, while 1% cases presented with mastoid abscess, 1.5% with exposed facial nerve, 1.2% with exposed sigmoid sinus and 0.25% with Bezold abscess. Intracranial complications were seen in nine patients. CONCLUSION: Cholesteatoma was found to be associated with most of the complications in cases of un-safe type of C.S.O.M. The complication rate in this study is lesser than that observed in our neighboring countries like Bangladesh, but still higher as compared to the developed countries. Cholesteatoma was also found in two cases having central perforation which is unusual presentation.