Sinus Quiz

Complete the following Sinus Self-Assessment Quiz and someone from our office will contact you to discuss your responses and possible next steps.

None

Slight

Mild

Bad

Intense

Severe

1. Clogged nose

x

x

x

x

x

x

2. Runny nose

x

x

x

x

x

x

3. Post nasal discharge

x

x

x

x

x

x

4. Thick nasal discharge

x

x

x

x

x

x

5. Facial pain / pressure

x

x

x

x

x

x

6. Fatigue

x

x

x

x

x

x

7. Need to blow nose

x

x

x

x

x

x

8. Loss of smell or taste

x

x

x

x

x

x

9. Ear fullness

x

x

x

x

x

x

10. Difficulty falling asleep

x

x

x

x

x

x

11. Waking up at night

x

x

x

x

x

x

12. Lack of good night's sleep

x

x

x

x

x

x

13. Waking up tired

x

x

x

x

x

x

14. Reduced productivity

x

x

x

x

x

x

15. Frustrated / irritable

x

x

x

x

x

x

16. Reduced concentration

x

x

x

x

x

x

17. Embarrassed

x

x

x

x

x

x

18. Sad

x

x

x

x

x

x

19. Ear pain

x

x

x

x

x

x

20. Cough

x

x

x

x

x

x

Click the submit button below to share your Sinus Self-Assessment Quiz results with our office.