Introduction: Sinonasal Tract (SNT) lesions are frequently observed in the Ear, Nose and Throat (ENT) practice. These lesions have identical appearance and usually present with nasal obstruction, but have varying differential diagnosis that requires histopathological confirmation. Though a common pathology, studies correlating clinical and histopathological diagnosis of SNT lesions are scarce among patients residing in Central India. Aim: To assess the prevalence of various lesions in SNT, compare the lesion in relation to age and sex, and simultaneously relate the clinical and histopathological diagnosis. Materials and Methods: This was a cross-sectional study carried out, in the Department of ENT and Head and Neck Surgery, Gajraraja Medical College, Gwalior, Madhya Pradesh, India, between May 2019 to December 2020. A total of 109 patients with SNT lesions were evaluated and a provisional diagnosis was reached after evaluating the history, and performing the clinical examination. The SNT lesions were excised operatively and definitive diagnosis was reached after histopathologic examination. Finally, clinical diagnosis was related with histopathologic diagnosis and percentage of patients in which clinical diagnosis similar to the histopathological diagnosis was calculated. Results: A total of 109 patients with SNT lesions were evaluated and the most common age groups to be affected were 21-30 and 31-40 years (22.9% each). Majority of the patients were males (53.2%) and had the complaints for the last three months to a year (63.3%). The most common complaint was nasal obstruction (93.6%) followed by rhinorrhoea (71.6%). Most common types of lesions were non neoplastic (77.1%). Among the neoplastic lesion, majority were benign (70.8%). Among various lesions, inflammatory nasal polyp (78.8%), haemangioma (47.1%), and Squamous Cell Carcinoma (SCC) (57.1%) were the most commonly observed non neoplastic, benign, and malignant lesions, respectively. The concordance between clinical and histopathological diagnosis was 88.1%, as 96 patients out of 109 clinically diagnosed patients, were confirmed on histopathology. Conclusion: The SNTs lesions are complex and their nature varies widely. The histopathological examination is essential to confirm the diagnosis and manage the patients, especially in patients with malignant lesions.