Background: Allergic rhinitis (AR) is immunoglobulin E (IgE)-mediated inflammation of the nasal mucosa on exposure to allergens. Hypertrophic rhinitis (HR) is a common complication for AR, and often need turbinate surgery. Montelukast was evidenced to have an effective role in treatment in AR. Objective: The aim of the current work was to correlate between radiological and total nasal symptom severity score (TNSSS) effect of montelukast in patient with allergic rhinitis associated with inferior turbinate hypertrophy. Patients and methods: This prospective comparative case control study included a total of 100 allergic patients suffering from nasal obstruction due to inferior turbinate hypertrophy (study group) and 100 non-allergic patients (control group), attending at Outpatient Clinics, ENT Department, Al-Azhar University Hospitals, Egypt. The effect Montelukast was assessed by (TNSSS), radiologically by (CT) scan. Serum levels of IgE, TGF-β and IL13 were measured. Result: Montelukast showed improvement of all nasal symptoms score with highly significant improvement TNSSS (P=0.003) and significant reduction on inferior turbinate size (p=0.001) compared to control. In addition to, significant reduction in serum levels of IgE, TGF-β and IL13. Conclusion: Montelukast could be effective alternative treatment for inferior turbinate hypertrophy.