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Sino – Nasal Outcome Test (SNOT – 22)

How to complete this Questionnaire:

  • Below you will find a list of symptoms and social/emotional consequences of your rhinosinusitis.
  • We would like to know more about these problems and would appreciate your answering the following questions to the best of your ability.
  • There are no right or wrong answers, and only you can provide us with this information.
  • Please rate your problems as they have been over the past two weeks.

Considering how severe the problem is when you experience it and how frequently it happens, please rate each item below on how “bad” it is by selecting the answer corresponds with how you feel

0 = No problem
1 = Very Mild problem
2 = Mild or slight problem
3 = Moderate problem
4 = Severe problem
5 = Problem as bad as it can be
Need to blow nose
Sneezing
Runny Nose
Cough
Post-nasal discharge (dripping at the back of your nose)
Thick Nasal Discharge
Ear Fullness
Dizziness
Ear Pain
Facial pain/Pressure
Difficulty falling asleep
Wake up at night
Lack of a good night's sleep
Wake up tired
Fatigue
Reduced productivity
Reduced concentration
Frustrated/restless/irritable
Sad
Embarrassed
Sense of taste/smell
Blockage/congestion of nose

First Name
Surname
DOB
Email
Phone number
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Time is Up!

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