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SNOT 22 Questionnaire

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.
1
Need to blow nose
2
Sneezing
3
Runny Nose
4
Cough
5
Post-nasal discharge (dripping at the back of your nose)
6
Thick Nasal Discharge
7
Ear Fullness
8
Dizziness
9
Ear Pain
10
Facial pain/Pressure
11
Difficulty falling asleep
12
Wake up at night
13
Lack of a good night's sleep
14
Wake up tired
15
Fatigue
16
Reduced productivity
17
Reduced concentration
18
Frustrated/restless/irritable
19
Sad
20
Embarrassed
21
Sense of taste/smell
22
Blockage/congestion of nose
First Name
Last Name
Email
Phone
  • 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
Excel ENT Surgeons

Contact

PHONE

(03) 9088 8222

Excel ENT Surgeons fax

FAX

(03) 9088 8223

CONSULTING LOCATIONS

Excel Camberwell
607–609 Riversdale Road,
Camberwell VIC 3124

Offspring Paediatrics
614 Glenferrie Road,
Hawthorn VIC 3122