<p>Adenoid hypertrophy (AH) is a common paediatric condition that can cause nasal obstruction, mouth breathing, snoring, and significant otologic complications such as otitis media with effusion (OME), hearing loss, and tympanic membrane changes. Despite this, the correlation between endoscopic grading of adenoids and otologic manifestations remains inadequately explored. To evaluate otologic symptoms and signs in children with adenoid hypertrophy and correlate them with endoscopic grading. This is a cross-sectional observational study conducted at a tertiary care center. Children aged 6–15&#xa0;years presented with symptoms suggestive of adenoid hypertrophy, including snoring, mouth breathing, nasal obstruction, and ear-related complaints, were included. Detailed clinical evaluation including otoscopy and nasal endoscopy using a 2.7&#xa0;mm 0-degree rigid endoscope was performed. Adenoid size was graded from I to IV using the Cassano classification. Otoscopic findings were documented. Pure tone audiometry (PTA) was done in cases of hearing complaints or signs of OME, and even in suspected cases without complaints to detect silent hearing loss. Data was analyzed to assess the relationship between adenoid grade and otologic findings. A significant association was found between higher grades of adenoid hypertrophy and increased incidence of otologic symptoms such as ear fullness, hearing loss, and tympanic membrane retraction. Grade III and IV AH were more frequently associated with abnormal otoscopic findings and conductive hearing loss on PTA. Cases of silent hearing loss were also detected in patients with signs of OME but no subjective hearing complaints. This study provides a comprehensive comparison between otologic clinical presentations and endoscopic grading of adenoid hypertrophy in paediatric patients. The findings underscore the significant burden of upper airway obstruction and associated otologic symptoms in children with moderate to severe adenoid hypertrophy.</p>