Background: The impact of infection and obstruction from tonsil and adenoid on the related anatomical structure like nose and paranasal sinus, Eustachian tube , and middle ear cleft are well established.1 Aim: To assess the size of adenoids in relation to nasopharyngeal space using digital X–ray lateral view of nasopharynx and correlate the Adenoidal Nasopharyngeal Ratio with middle ear function measured using tympanometry. Materials And Methods: This prospective study involves children reporting to the Department of ENT at CSSH, SVSU, Meerut. A total of 50 cases of clinically and radiologically diagnosed adenoid hypertrophy were studied and subjected to Tympanometry to assess middle ear function. Results: Our study shows that, as the Adenoidal Nasopharyngeal Ratio increases, the number of B–type and C–type Tympanogram were also increasing, correlating that the increase in adenoid size will have some pathological affect on middle ear. Conclusion: The digital X–ray Nasopharynx lateral view provides a reliable method for determining whether the adenoid hyperplasia is clinically significant or not. The children with significant pathological enlargement should be subjected to Tympanometry at the earliest to diagnose effects of adenoid hypertrophy over the Eustachian tube and in turn over the middle ear function.