. 2015 Oct 20;78(6):34–39. doi: 10.5935/1808-8694.20120030

Chart 1.

Final Version of the SNOT-22 Questionnaire. SNOT-22 Sinonasal Outcomes Questionnaire.

Name:______________________Date:__/__/___
Below, there is a list of symptoms and social/emotional consequences associated with your nasal problem. We would like to know more about these problems, and we appreciate your time in answering these questions to the best of your abilities. There are no correct or wrong answers, and only you can provide us with this information. Please quantify your problems and how they have presented in the last two weeks. Thank you for your participation.
A: Please, read the symptoms below, numbered from 1 to 22. Following, use the scale to the side to quantify the severity of your problem and the frequency at which it happens. To end, please circle the number corresponding to how bad you feel →	No problem	Very Mild Problem	Mild or light problem	Moderate problem	Severe problem	Very severe problem
1. Need to blow your nose	0	1	2	3	4	5
2. Sneezing	0	1	2	3	4	5
3. Running nose	0	1	2	3	4	5
4. Cough	0	1	2	3	4	5
5. A feeling of secretion running down the back of your nose	0	1	2	3	4	5
6. Thick secretion in the nose (thick mucous in the nose)	0	1	2	3	4	5
7. Stuffed ear (clogged ear)	0	1	2	3	4	5
8. Dizziness	0	1	2	3	4	5
9. Ear ache	0	1	2	3	4	5
10. Facial pain or pressure	0	1	2	3	4	5
11. Difficulty falling asleep	0	1	2	3	4	5
12. Waking up in the middle of the night	0	1	2	3	4	5
13. Lack of a good night of sleep	0	1	2	3	4	5
14. Wake up tired in the morning	0	1	2	3	4	5
15. Tiredness/fatigue throughout the day	0	1	2	3	4	5
16. Reduced productivity (lower performance)	0	1	2	3	4	5
17. Reduced concentration	0	1	2	3	4	5
18. Frustrated/impatient/touchy	0	1	2	3	4	5
19. Sad	0	1	2	3	4	5
20. Embarrassed	0	1	2	3	4	5
21. Perception of olfaction (smell) or taste	0	1	2	3	4	5
22. Clogged/stuffed nose	0	1	2	3	4	5
Total		____	____	____	____	____
					Total General_______