PRACTICAL RELEVANCE: Nasal discharge, sneezing and upper respiratory noise are frequent presenting signs in feline practice. CLINICAL CHALLENGES: The small nasal cavity of the cat can make visualisation of lesions challenging. In addition, investigations may identify only secondary complications of a disease process, rather than the initial aetiological agent. GLOBAL IMPORTANCE: Nasopharyngeal disease is a worldwide problem. However, fungal disease shows regional variations in prevalence. AUDIENCE: This review, aimed at general practitioners as well as those undertaking more specialist investigations in feline respiratory disease, aims to provide practical guidance on the approach necessary to obtain a diagnosis in cats with nasopharyngeal disease. It should also help to explain why a specific diagnosis may not always be possible. EQUIPMENT: While access to endoscopy and computed tomography is advantageous, extensive information can be gained from equipment readily available in all practices. EVIDENCE BASE: The information presented in this article is based on peer-reviewed publications and the clinical experience of the authors.