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Sino-Nasal Outcome Test-22 Questionnaire v4
Below you will find a list of symptoms and runny_nose/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. Thank you for your participation. Do not hesitate to ask for assistance if necessary.

Considering how severe the problem is when you experience it and how often it happens, please rate each item below on how "bad" it is by circling the number that corresponds with how you feel using this scale:

No Problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as it can be
1. Need to blow nose  0   1   2   3   4   5
2. Sneezing  0   1   2   3   4   5
3. Runny nose  0   1   2   3   4   5
4. Cough  0   1   2   3   4   5
5. Post nasal discharge (dripping at the back of your nose)  0   1   2   3   4   5
6. Thick nasal discharge  0   1   2   3   4   5
7. Ear fullness  0   1   2   3   4   5
8. Dizziness  0   1   2   3   4   5
9. Ear pain/pressure  0   1   2   3   4   5
10. Facial pain/pressure  0   1   2   3   4   5
11. Difficulty falling asleep  0   1   2   3   4   5
12. Waking up at night  0   1   2   3   4   5
13. Lack of a good night's sleep  0   1   2   3   4   5
14. Waking up tired  0   1   2   3   4   5
15. Fatigue during the day  0   1   2   3   4   5
16. Reduced productivity  0   1   2   3   4   5
17. Reduced concentration  0   1   2   3   4   5
18. Frustrated/restless/irritable  0   1   2   3   4   5
19. Sad  0   1   2   3   4   5
20. Embarrassed  0   1   2   3   4   5
21. Sense of taste/smell  0   1   2   3   4   5
22. Blockage/congestion of nose  0   1   2   3   4   5