Chronic nasal obstruction due to adenoid hypertrophy is among the most common health problems affecting children, and adenoidectomy is one of the most common surgical procedures performed in this age group Because of difficulties associated with the use of the objective methods (such as nasopharyngeal endoscopy) in young children, the development of a reliable scale based on the child's symptoms to properly evaluate the need for surgical intervention would be of great value for clinicians. When adenoidectomy is being considered, the diagnosis and documentation of adenoidal hypertrophy become an important issue. Numerous modalities have been used for this task, including trans oral digital palpation and trans oral mirror examination; however, these methods are quite impractical with uncooperative younger children

Assessment of the nasopharynx and adenoids by fibreoptic examination bears the advantage of direct visualization of the postnasal space. In addition, previous studies have demonstrated that adenoid size, as determined by rhinoscopy, was well correlated with clinical symptoms such as nasal obstruction and snoring.

The aim of this study was to compare the effectiveness of lateral neck radiography and video rhinoscopy in assessing adenoid size .

Assessment of the reproducability of these modalities to associated symptoms and, thus, the severity of the disease.

Inclusion Criteria:

• children aged 3 _ 14 years old
• clinical diagnosis of adenoid hypertrophy in the form of chronic oral respiration , nasal disorders and snoring
• recurrent otitis media

Exclusion Criteria:

1. patients diagnosed with nasal obstruction due to anatomic malformation ( congenital, choanal atresia, stenosis or septal deviation )
2. age less than 3 years or more than 14 years
3. patient with craniofacial malformation and down syndrome