SNOT-16, SNOT-20, SNOT-22, SNOT-25

Author: Jay Piccirillo, MD

About SNOT

The SNOT instrument is a collection of several validated instruments (SNOT-16, SNOT-20, SNOT-22, SNOT-25) defined by the number of included items. All of the SNOT instruments are derived from the Rhino-Sinusitis Outcome Measure (RSOM-31) (Piccirillo et al. 1995).

See a sample copy of SNOT-25 (PDF) »

See a sample copy of SNOT-22 (PDF) »

The SNOT-16, SNOT-20, SNOT-22, and SNOT-25 are copyright protected by Washington University in St. Louis.

The scores of each question range from 0 to 5, according to the severity of the symptom, with 5 being the worst. The score of the test is the sum of the question scores. Higher scores represent a lower health related-quality of life.

In addition, patients identify the five items that affect them the most. Typically, the impact of treatment is assessed with the SNOT Absolute Change Score.

Learn about the SNOT scoring system »


Chronic rhinosinusitis (CRS) is the second most frequent reported chronic health condition (after arthritis), affects up to 14% of the US population, and results in significant disease burden in patients (Vital Health Stat 10. 2014;(260):1–161).

The best approximation of CRS disease burden, defined as its impact on a patient’s functional status and disease-related quality of life, is to use patient-reported outcome measures (PROM) (Benninger et al. 2003; Morley and Sharp 2006).

The most widely used PROM for CRS patients is the Sino-Nasal Outcome Test (SNOT) instrument.