Tobacco smoking and exposure to environmental tobacco smoke (ETS) have both been implicated in a number of acute and chronic medical problems including heart and lung disease and several cancers. The impact of tobacco smoke on disorders of the nose and paranasal sinuses is less well understood, although there is growing evidence that such exposure can have a significant impact on nasal and sinus function. A comprehensive review of the literature reveals that tobacco smoking is associated with acute and chronic rhinitis, but may actually be negatively correlated with the development of allergic rhinitis. In those patients with allergies, nasal and sinus symptoms may be exacerbated by tobacco smoking. ETS exposure is associated with acute and chronic nasal symptoms in adults and children, snoring in children and teenagers, and may be associated with an earlier onset and more significant symptoms for individuals with a predisposition to developing allergies. Both primary and environmental tobacco smoke are related to increases in nasal and sinus cancer. Tobacco smoking and ETS are associated with significant nasal and sinus disease and cancer.