Sinus Questionnaire

Is Balloon Sinuplasty Right for You? Yes No
1 Have you experienced four or more sinus infections in the past year?
2 Have you had a sinus infection for 12 weeks or more that is not responding to medication?
3 Has a physician prescribed you sinus medication to address your symptoms?
Do you experience any of the following symptoms?
4 Facial pain
5 Facial pressure
6 Sinus headaches
7 Discharge of yellow or green mucus from the nose
8 Congestion
9 Decreased sense of smell
10 Lack of a good night’s sleep

The sinus questionnaire indicates that Balloon Sinuplasty may not be required, however we recommend you see Dr. Rosner for an accurate diagnosis and evaluation.

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Based off of the results, we highly recommended you see Dr. Rosner for an accurate diagnosis and evaluation of treatment options. Balloon Sinuplasty may be right for you.

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