Adenoid hypertrophy is known as the most common cause of nasal obstruction in children; thus, adenoidectomy with, or without, tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Although many methods have been suggested, few studies have reported on how to assess adenoid size, pre-operatively. Acoustic rhinometry is an objective technique as well as a non-invasive method, which can be easily used in young children. This study confirmed that acoustic rhinometry is a non-invasive and objective technique for assessing the geometry of the nasal cavity and nasopharynx. Forty children were evaluated using symptomology, two different radiological measurements and acoustic rhinometry; the results were compared with endoscopic findings. Clinical symptoms and A/N ratio measured with Fujioka's method significantly correlated with the endoscopic assessment findings (r = 0.769 and 0.604 respectively). Significant increases in the cross-sectional area and volume of the nasopharynx were observed at the adenoid notch after adenoidectomy (p < 0.005 and p < 0.005, respectively). Acoustic rhinometry showed a high degree of correlation of which adenoid occupied the nasopharyngeal airway under endoscopic examination (r = 0.771). Thus, the study concluded that acoustic rhinometry can be as good an objective method for measuring adenoid sizes as endoscopy and can be used as one of the pre-operative examination tools for adenoidectomy.