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Objective We assessed upper-aero digestive tract disorders in World Trade Center (WTC) patients seen in the Otolaryngology – Head and Neck Surgery Department of a large New York City hospital system and the association between WTC exposure and sinonasal surgery for chronic rhinosinusitis (CRS).Methods Retrospective review of medical records of all WTC patients seen between July 2002 and December 2023. Primary exposure was measured by arrival date and exposure length to the disaster site. Primary outcomes were upper-aero digestive tract disorders and sinonasal surgery.Results 3118 WTC patients were reviewed. Of these, 1162 (37.3%) had CRS. CRS patients were more likely female (p=0.03) and had higher proportion of comorbid obstructive sleep apnoea (OSA) (p<0.0001), allergic rhinitis (p<0.0001) and gastro-oesophageal reflux disease (p<0.0001). 355 (31.0%) CRS patients underwent sinonasal surgery. Relative to the medically managed patients, surgical CRS patients were younger at time of 9/11 (p=0.006), had a higher proportion of comorbid OSA (p=0.02) and earlier exposure (arrival date 11 September–13 September prior to rainfall) (p=0.001). CRS patients with early exposure demonstrated significantly greater odds of undergoing sinonasal surgery compared with those with late exposure (adjusted OR 1.61; 95% CI 1.2 to 2.3).Conclusions Earlier arrival at WTC site increased the risk of needing surgery for responders with CRS. Higher levels of irritant exposure prior to rainfall on 14 September 2001 may have caused significant epithelial injury to the sinonasal mucosa of WTC patients, leading to an elevated prevalence of CRS requiring surgical intervention.