Background: The upper airway is an extraordinarily complex anatomical region. Anticipating and preparing for difficulty in airway management is crucial to avoid airway catastrophes. Objective: Aim of our study was to evaluate the combination of El-Ganzouri airway risk index (EGRI) with the ultrasound of the airway (measuring the hyomental distance and distance from epiglottis to midpoint between the two vocal cords) as a fast, easy and noninvasive method in the examination of the airway and prediction of difficult airway. Patients and methods: Preoperative airway assessment will be carried out for 60 adult patients randomly allocated in Al-Azhar University Hospitals. Results: The hyomental distance at cutoff point of 5.6 cm, (below which the intubation difficulty is high), sensitivity and specificity of Cormack-Lehane grade with hyomental distance in study group was75.0% and 94.4% respectively with accuracy of 85%. For the epiglottis to vocal cord distance the cut off value of ≤ 1.2 (below which the intubation difficulty is high) the sensitivity of epiglottis to vocal cord distance was 75.0% and the specificity was 100% with accuracy of 92%. Conclusion: We concluded that combination of EGRI with epiglottis to vocal cord distance and hyomental distance is a very sensitive and specific tool for prediction of difficult airway and may be superior to standard methods of assessment.