<p>Adenoid hypertrophy is commonly seen in the age group of 3–15 years and peaks at the age of 6-10years. Mouth breathing and snoring are the most common complaints associated with adenoid hypertrophy. Long standing cases results in eustachian tube dysfunction, otitis media with effusion, conductive hearing loss, delayed speech and language development. This study aims to determine the correlation between severity of symptoms and radiological grading of adenoid hypertrophy.&#xa0;This cross-sectional, observational study was conducted over 18 months in the Department of Otorhinolaryngology at a tertiary care center. It included 82 patients aged 3–14 years with mouth breathing and snoring. Demographic data, clinical features, and symptoms were collected. lateral neck X-rays, radiological grading of adenoid hypertrophy was done using Xray Nasopharynx lateral view.&#xa0;The study showed male predominance (63.4%) with a mean age of 3–5 years. Common symptoms included snoring and mouth breathing. Turbinate enlargment was present in 28% children.&#xa0;More than half of the children had an ANR &gt; 0.7, indicating significant nasopharyngeal obstruction. A highly significant association was observed, with increasing clinical severity corresponding to higher radiological scores (p &lt; 0.0000001).</p>