Aims and objectives: In our study, we tried to analyze the utility of X-ray nasopharynx and nasal endoscopy in assessing the size of the adenoid tissue and thereby grading chronic adenoiditis. The grading of adenoids was correlated clinically with the severity of symptoms attributed to chronic adenoiditis. Materials and methods: Our study was an observational prospective study of 80 children with a diagnosis of chronic adenoiditis conducted in the Dept of ENT from January 2019 to 2020. The digital X-ray nasopharynx lateral view and nasal endoscopic results of all patients were analyzed, graded, and compared. Results: The most common age group was 5–7 years which included 34 children (42.5%). Mean adenoid–nasopharyngeal ratio for which otitis media with effusion (OME) was present was 0.72 which corresponds to X-ray grade II. It was also noticed that 71.4% X-ray grade III had OME and 65.8% of cases of endoscopic grade III adenoid had OME. Conclusion: X-ray nasopharynx was found to be a simple, less costly, practically easy option in a day-to-day practice in assessing the size of adenoid tissue; whereas nasal endoscopy is a more scientific approach providing three-dimensional views of the adenoids in the nasopharyngeal compartment. Lateral extensions of adenoids to eustachian tube orifices can be noticed in nasal endoscopy. Nasal endoscopy is considered the gold standard in diagnosing chronic adenoiditis. Reaching the correct diagnosis of chronic adenoiditis at the earliest is the main key in treatment to prevent complications and sequelae related to this clinical condition. Clinical significance: Both X-ray nasopharynx and nasal endoscopy are useful tools in the diagnosis of chronic adenoiditis. Grading of adenoids can be done in both techniques. While X-ray tomogram is a cheap and convenient method, nasal endoscopy is more scientific and accurate in giving a three-dimensional view of adenoids.