BACKGROUND: Obstructive adenoid enlargement is a common ailment encountered in Paediatric-Otolaryngological practice yet there is paucity of information on its clinical presentation and epidemiology in Nigeria. The causal relationship between the size of the adenoids and and development of otitis media with effusion (OME) is still a controversial subject. AIM: The aim of this study is to obtain basic data on the pattern of obstructive adenoid disease among children and to evaluate correlation, if any, between adenoid enlargement and otitis media with effusion. METHODOLOGY: It was 1-year hospital-based, descriptive, cross-sectional study in which consecutive eligible patients aged 0-15 years were recruited from all the new patients aged 0-15 years that attended the ENT clinics of UNTH Enugu between April 2004 and March 2005. RESULTS: The study showed 16.6% prevalence of obstructive adenoid enlargement with a significant male preponderance of 1.9 :1 (X2=4.07; P<0.05). The peak age at presentation was in the age range of 0-3 years. The commonest presenting symptoms were Snoring (98.4%), mouth- breathing (96.9%) and nasal obstruction (78.1%).Prevalence of OME= 39%. CONCLUSION: Obstructive adenoid enlargement was a common clinical presentation mostly among younger children and males. Otoscopy was comparable to tympanometry, though less reliable, in the diagnosing of OME. Obstructive adenoid enlargement was a causative factor of the OME, but there was no 2 correlation between the degree of nasopharyngeal obstruction by the adenoids and the presence of OME (r =0.109; P>0.05 ). Key Words: Adenoid enlargement, Nasopharyngeal obstruction, Otitis media with effusion, Nigeria