Sino-Nasal Outcome Test (SNOT-20) Rate the severity of your nasal symptoms over the past two weeks. After entering all ratings, please indicate the symptoms you hope will improve the most with treatment (up to 5). After submitting your answers, your total and average scores will be calculated. A score less than 2 is considered normal, greater than or equal to 2 is abnormal. 1. Need to blow nose No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 2. Sneezing No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 3. Runny nose No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 4. Cough No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 5. Post-nasal discharge No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 6. Thick nasal discharge No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 7. Ear fullness No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 8. Dizziness No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 9. Ear pain No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 10. Facial pain/pressure No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 11. Difficulty falling asleep No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 12. Wake up at night No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 13. Lack of good night's sleep No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 14. Wake up tired No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 15. Fatigue No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 16. Reduced productivity No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 17. Reduced concentration No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 18. Frustrated / restless / irritable No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 19. Sad No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None 20. Embarrassed No problem Very mild problem Mild or slight problem Moderate problem Severe problem Problem as bad as can be None Indicate the symptoms you hope will improve most with treatment (up to 5) Need to blow nose Sneezing Runny nose Cough Post-nasal discharge 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 First Name Last Name Email Phone Date of Birth Time's up
