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Sinus Health Check

Please answer the following questions. You will obtain a brief evaluation of your sinus health, as well as some information and advice.


yes


no

Are you part of one of the following groups: allergy sufferers (pollen, dust mites), smokers, asthmatics?

yes


no

Do you suffer from one of the following: frequent colds, nasal cavity deviation, post nasal drip?
IF YOU ALREADY HAVE A COLD...


1-2 days


3-4 days


5-7 days


> 7 days


> 14 days
How long have you had a cold?

transparent, liquides

transparent, viscous

yellow-green, viscous
What does your nasal secretions look like (color and texture)?

yes

no
Do you suffer from sinus headaches?

yes

no
Do you suffer from facial pain: cheek, forehead, nose or between the eyes?

yes

no
Is this pain worse if you apply external pressure or light touch?

yes

no
Are headaches and facial pain worse if you bend forward or if you sneeze?

yes

no
Do you find it difficult to perceive odors or is food tasteless?

yes

no
Do you have a fever?

yes

no
Do you feel tired or exhausted?

Total number of points




Evaluation