Reflux Symptom Index
return to: Extraesophageal reflux disease
Within the last month, how did the following problems affect you?
Circle the appropriate number that best applies to your symptoms.
0 = No Problem
5 = Severe Problem
- Hoarseness or a problem with your voice.
0 1 2 3 4 5 - Clearing your throat.
0 1 2 3 4 5 - Excess throat mucus or postnasal drip.
0 1 2 3 4 5 - Difficulty swallowing food, liquids, or pills.
0 1 2 3 4 5 - Coughing after you ate or after lying down.
0 1 2 3 4 5 - Breathing difficulties or choking episodes.
0 1 2 3 4 5 - Troublesome or annoying cough.
0 1 2 3 4 5 - Sensations of something sticking in your throat or a lump in your throat.
0 1 2 3 4 5 - Heartburn, chest pain, indigestion, or stomach acid coming up.
0 1 2 3 4 5
Belafsky PC, Postma GN, Koufman JA. Validity and reliabiltiy of the reflux symptom index (RSI). Journal of Voice 2002, 16(2):274-277