This is a prospective comparative study of adenoid size assessment by using radiography versus nasopharyngoscopy using examination of the adenoid under general anesthesia (GA) as a standard method. This study was conducted on 35 children presented with signs and symptoms of adenoid hypertrophy. All patients were examined by both lateral radiograph view of the postnasal space and nasopharyngoscopy, then both results were compared. The results for small size adenoid can not be calculated because of small sample size. For medium sized adenoid, the sensitivity for radiography and nasopharyngoscopy are 36.36%, 54.54% respectively, the specificity was 47.36%, 84.21% respectively and the accuracy was 43.33%, 73.33% respectively. For large sized adenoid the sensitivity for radiography and nasopharyngoscopy was 38.89%, 83.33% respectively, the specificity was 100%, 66.66% respectively, and the accuracy was 63.33%, 76.66% respectively. In conclusion, nasopharyngoscopy is a simple, safe, repeatable, readily available at the ENT unit, with no radiation hazards, and with negligible trauma. Over all, nasopharyngoscopy has a higher sensitivity, specificity and accuracy than radiography.