Background <p>Adenoid hypertrophy is common in children and can cause several symptoms including nasal obstruction, mouth breathing and obstructive sleep apnoea. The popular method used in present era is X-ray nasopharynx which is the primary investigation used in evaluation of adenoid hypertrophy. It has the risk of exposure to radiation and the head posture may not be correct due to insufficient coordination of children. On the other hand, ultrasonography can be used to assess not only the size but also the shape and blood flow of adenoids. In this study, we have assessed the role of ultrasonography in diagnosing adenoid hypertrophy.</p> Objective <p>To evaluate adenoid hypertrophy on X-ray Nasopharynx and ultrasonography neck.</p> Method <p>This observational, cross-sectional study included 65 patients who presented with symptoms of adenoid hypertrophy. The antero-posterior thickness and adenoid/nasopharynx (A/N) ratio were measured on X-ray nasopharynx and ultrasonography of neck. Comparison of the findings obtained on both imaging modalities was done.</p> Result <p>The statistical analysis was done and the correlation between X-ray and ultrasonography findings was found to be significant. On analysis of results, USG Nasopharynx was found reliable as a diagnostic tool in patients having adenoid hypertrophy and it can be used as an aid for preoperative investigation.</p> Conclusion <p>A significant correlation was observed between the anteroposterior (AP) and adenoid nasopharyngeal ratio (ANR) values measured via both X-Ray and ultrasonography (USG). These findings suggest that USG holds promise as a reliable tool for assessing adenoid hypertrophy.</p>