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Sino-Nasal Outcome Test-22 & NOSE Questionnaire

Results are used for audit purposes
Your name is to match up the pre- and post-operative scores
(otherwise all data is anonymised)
1.Name
2.Is this questionnaire before or after surgery?
3.Surgery performed under the care of
4.Sino-Nasal Outcome Test-22 Questionnaire

Please rate your problems, as they have been over the past two weeks.
No problem
Very mild problem
Mild or slight problem
Moderate problem
Severe problem
Problem as bad as it can be
Need to blow nose
Sneezing
Runny nose
Cough
Post nasal discharge (dripping at the back of your nose)
Thick nasal discharge
Ear fullness (pressure)
Dizziness
Ear pain
Facial pain/pressure
Difficulty falling asleep
Waking up at night
Lack of a good night’s sleep
Waking up tired
Tiredness during the day
Reduced productivity
Reduced concentration
Frustrated/restless/irritable
Sad
Embarrassed
Loss of taste/smell
Blockage/congestion of nose
5.NASAL OBSTRUCTION SYMPTOM EVALUATION (NOSE) Score

Over the past 1 month, how much of a problem were the following conditions for you?
No problem
Mild
Moderate
Severe
Nasal congestion or stuffiness ('snotty')
Nasal blockage or obstruction
Trouble breathing through my nose
Trouble sleeping
Unable to get enough air through my nose during exercise