Sino-Nasal Outcome Test (SNOT-20)

Sinus Survey

The following questionnaire is intended to help define your symptoms and provide valuable information and insights for Dr. Leeman. Answer the questions, rating to the best of your ability the problems you have experienced over the past two weeks.  After completing the survey, please print this page and bring it to your appointment.

1. Consider 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 ticking the radio button that corresponds with you feel.

No problem Very
mild problem
Mild or slight problem Moderate problem Severe problem Problem as bad as it can be

0 1 2 3 4 5
1. Need to blow nose
2. Sneezing
3. Runny nose
4. Cough
5. Post-nasal discharge
6. Thick nasal discharge
7. Ear fullness
8. Dizziness
9. Ear pain
10. Facial pain / pressure

No problem Very
mild problem
Mild or slight problem Moderate problem Severe problem Problem as bad as it can be

0 1 2 3 4 5
11. Difficulty falling asleep
12. Wake up at night
13. Lack of sleep
14. Wake up tired
15. Fatigue
16. Reduced productivity
17. Reduced concentration
18. Frustrated / restless / irritable
19. Sad
20. Embarrassed
SCORE:


Score Evaluation Recommended Next Step
0 to 10 No problem to mild problem No actions necessary or symptoms can be treated with OTC medication.
11 to 40 Moderate problem An appointment with a specialist or your PCP is recommended and/or prescription medicine can be taken to treat symptoms.
41 to 69 Moderate to severe An appointment with a specialist or your PCP is recommended and/or prescription medicine can be taken to treat symptoms.
70 to 100 Severe to “as bad as it can be” And appointment with a specialist is recommended, treatment to be determined by doctor. Possible surgical candidate.
*The SNOT score evaluation is to be used as a guide and not a physician’s diagnosis. Treatment to be determined by doctor upon appointment.
 

Frequently Asked Questions