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Reflux Symptom Index (RSI)

last modified on: Mon, 08/21/2017 - 14:40

 

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

  1. Hoarseness or a problem with your voice. 

                0     1     2     3     4     5
  2. Clearing your throat. 

                0     1     2     3     4     5
  3. Excess throat mucus or postnasal drip.  

                0     1     2     3     4     5
  4. Difficulty swallowing food, liquids, or pills.  

                0     1     2     3     4     5
  5. Coughing after you ate or after lying down. 

                0     1     2     3     4     5
  6. Breathing difficulties or choking episodes. 

                0     1     2     3     4     5
  7. Troublesome or annoying cough. 

                0     1     2     3     4     5
  8. Sensations of something sticking in your throat or a lump in your throat.  

                0     1     2     3     4     5
  9. 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