Head and Neck squamous cell carcinoma (HNSCC) is one of the most common cancer in developing countries. Most of the patients present with advanced disease and requires rigorous treatment. Routine follow up of the patient is required to detect any recurrence which will substantially affect overall survival of the patient. Narrow Band Imaging is one of the advanced endoscopic modalities which can be used for assessment of the patients during follow-up along with White light examination (WLE) and WB PETCT. An observational study to determine the efficacy and diagnostic accuracy of NBI in early detection of recurrence in follow-up patients with HNSCC was conducted comparing it with WLE, WB-PETCT and HPE. 60 patients who received definitive radiotherapy /Chemoradiotherapy (RT/CRT) for HNSCC were followed up for a period of 12 months with WLE, NBI, WB PETCT and was compared with HPE. NBI demonstrated higher sensitivity (95.45%) and specificity (97.37%) compared to WLE, which had sensitivity and specificity of 77.27% and 92.11%, respectively. NBI also had superior diagnostic accuracy (96.67%) versus white light (86.67%).WB-PETCT had sensitivity of 95.45% and specificity of 92.11% with a diagnostic accuracy of 93.33% for detecting local recurrences. NBI is a more sensitive and accurate tool for detecting early recurrences in HNSCC post RT/CRT, improving patient outcomes through timely intervention. Proper training and standardized interpretation protocols are essential for maximizing its clinical utility.