The upper airway plays a critical role in filtering and conditioning air for the lungs. It provides the first line of warning and defense against microbials, allergens, and toxic inhalants. Current evidence suggests that the upper airway is susceptible to many of the pathogenic processes that the agents cause in the lower respiratory tract. Work-related rhinosinusitis or vocal cord dysfunction should prompt physicians and employers to identify the injurious agent(s) and formulate strategies to eliminate or reduce such exposures. Improving the work environment will prevent the development of new cases and the worsening of symptoms in existing cases.