<p>Adenoid hypertrophy and chronic tonsillitis are common causes of upper airway obstruction in children and are frequently associated with Eustachian tube dysfunction, otitis media with effusion, and conductive hearing loss. These auditory deficits are often insidious and may adversely affect speech, language development, and academic performance if not identified and managed early. To evaluate the effect of various grades of adenoid hypertrophy and tonsillitis on hearing capacity in the paediatric age group and to assess hearing improvement following appropriate medical and surgical intervention. A prospective observational study was conducted at a tertiary care centre over two years. Sixty children aged four to eighteen years diagnosed with adenoid hypertrophy with or without tonsillitis were included. All patients underwent detailed clinical evaluation, radiological grading of adenoids, pure tone audiometry, and impedance audiometry. Based on disease severity, patients were managed with adenoidectomy with or without tonsillectomy, myringotomy, or grommet insertion. Preoperative and postoperative audiological findings were compared and statistically analysed. Grade three adenoid hypertrophy was the most common finding. Conductive hearing loss was significantly associated with higher grades of adenoid hypertrophy (<i>p</i> &lt; 0.001) and tonsillar hypertrophy (<i>p</i> &lt; 0.01). Type B tympanogram was the predominant impedance pattern. Postoperative assessment demonstrated a statistically significant improvement in hearing, with a mean air–bone gap reduction of 7.05 decibels, particularly in patients undergoing grommet insertion. Timely surgical intervention in children with adenoid and tonsillar hypertrophy results in hearing improvement.</p>