Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT)

If you have any questions, please call (352) 265-0920.

NOSE HHT Questionnaire

Below you will find a list of physical, functional, and emotional consequences of your nosebleeds. We would like to know more about these problems and would appreciate you answering the following questions to the best of your ability. There are no right or wrong answers, as your responses are unique to you. Please rate your problems as they have been over the past two weeks.
MM slash DD slash YYYY

Please rate how severe the following problems are due to your nosebleeds:

Blood running down the back of your throat(Required)
Blocked up, stuffy nose(Required)
Nasal crusting(Required)
Fatigue(Required)
Shortness of breath(Required)
Decreased sense of smell or taste(Required)

How difficult is it to perform the following tasks due to your nosebleeds?

Blow your nose(Required)
Bend over/pick something up from the ground(Required)
Breathe through your nose(Required)
Exercise(Required)
Work at your job (or school)(Required)
Stay asleep(Required)
Enjoy time with friends and family(Required)