Background: There is currently no established set of standardized ultrasonographic criteria that support the prediction of a difficult airway. The objective of this work is to assess airway characteristics by ultrasonography, including the pre-epiglottis space, the distance between the epiglottis and the midpoint of the vocal cords (Pre E/E-VC), and the ratio of hyomental distance in both normal and extended head angles. The objective of this study is to see if these measures can predict a difficult airway in patients by associating them with the intraoperative Cormack Lehane (CL) grading. Conducting a preoperative sonographic assessment of the airway provides favourable prediction results for difficult laryngoscopy procedures. Materials and Methods: A prospective observational study included 174 patients who were scheduled for elective surgery that mandated tracheal intubation and general anaesthesia. The midway vocal cord distance (E-VC) between the vocal cords and the epiglottis, as well as the pre-epiglottic gap (Pre-E) depth, were evaluated using ultrasound. Furthermore, the head was placed in both neutral and extended positions to determine the Hyomental distance ratio (HMDR) using sonographic methods. The main objective was to assess the ability of Pre-E/E-VC or HMDR to predict difficult laryngoscopy procedures performed on patients with Cormack-Lehane Grade 3, 4, or above. The second objective was to establish a correlation between these indicators and CL grade. Results: In this study, 17.8% of patients had difficulty with intubation. The Pre-E/E-VC ratio's mean ± standard deviation (SD) was 1.95±0.20 for difficult intubation (CL Grades 3 and 4) and 1.25±0.38 for easy intubation (CL Grades 1, 2) (P < 0.001). For simple intubation (CL Grades 1, 2), the HMDR mean ± SD was 1.30±0.05; for difficult intubation (CL Grades 3 and 4) it was 1.16±0.05 (P < 0.001). When predicting difficult Laryngoscopy, pre-E/E-VC ratios greater than 1.90 cm showed a 92% sensitivity and an 85 % specificity, while HMDR values less than 1.16 had a 70% sensitivity and an 85% specificity (P < 0.001). Conclusion: When compared to HMDR, the sonographic measurement of the Pre-E/E-VC ratio proves to be a more reliable indicator of CL grading. A pre-E/E-VC ratio greater than 1.90 indicates a challenging laryngoscopy case (CL Grade 3,4). This finding underscores the potential of ultrasonography to accurately predict CL grading, unlike HMDR. Therefore, the inclusion of ultrasonography in routine pre-anaesthetic examinations can significantly enhance the prediction of a problematic airway. Pre-E/E-VC and HMDR are indeed useful indicators for predicting difficult airways, and their significance cannot be overstated.