E-cigarette use increases the risk of allergic rhinitis and chronic rhinosinusitis. Numerous reports indicate that e-cigarette users are more likely to have nasal and paranasal symptoms in comparison to non-smokers. The increased risk of sinonasal symptoms can be attributed to inflammation of the mucosal lining, a decrease in mucociliary clearance, and alterations in the immune system. These act in concert to promote bacterial colonization and biofilm formation. This chapter provides an overview of the impact of e-cigarette use on the nose and paranasal sinuses.