There has been a recent resurgence of interest in implementing brachytherapy in the management of nasopharyngeal carcinoma, not only as treatment for recurrent disease, where it has secured a notable role, but also as an elective boost following external beam irradiation in an attempt to improve local control. Examination of the use of nasopharyngeal brachytherapy over nearly the last century may provide guidance for such endeavors and encourage further evolution of these techniques. Throughout this interval, ingenuity has prevailed in attempts to treat a secluded anatomical site which has been difficult to access, explore, and implant in an acceptable manner.