LARYNGOLOGY Self-Assessment Tools

These questions are subjective and do not replace a thorough history and laryngeal examination by a laryngologist.
However, abnormal scores do indicate the possibility of a true voice or swallowing problem that often can be treated.

If you have any problem with your voice, swallowing, or have a cough, take these brief subjective tests. Any abnormal
scores can be discussed a history and examination performed by Dr. Zalvan to determine the cause of your symptoms
Reflux Symptom Index (RSI)

Within the last MONTH how did the following problems affect you?          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 mucous 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 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

A RSI > 10 strongly suggests the presence of LPR. Visit Dr. Zalvan today to confirm and treat these symptoms
                                                                                                     
                                                                                                             Belafsky PC, Postma GN, and Koufman JA. Validity and reliability of the reflux symptom index (RSI). Journal of Voice. 2002. 16(2): 274-277.
Voice Handicap Index (VHI-10), Henry Ford Hospital
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Please circle the response that indicated how frequently you have these experiences:
0 = never   1 = almost never 2 = sometimes 3 = almost always 4 = always

My voice makes it difficult for people to hear me                                      0       1         2        3        4     
People have difficulty understanding me in a noisy room.                        0       1         2        3        4     
My voice difficulties restrict my personal and social life                            0       1         2        3        4     
I feel left out of conversations because of my voice                                 0       1         2        3        4     
My voice problem causes me to lose income                                           0       1         2        3        4     
I feel as though I have to strain to produce voice                                     0       1         2        3        4     
The clarity of my voice is unpredictable                                                   0       1         2        3        4     
My voice problem upsets me                                                                    0       1         2        3        4     
My voice makes me feel handicapped                                                     0       1         2        3        4     
People ask “What’s wrong with your voice?”                                            0       1         2        3        4

A VHI-10 score > 7 is considered abnormal and may indicate a problem with your vocal folds and voice box. See
Dr. Zalvan for a full evaluation with stroboscopy to identify a possible issue.


Rosen, C, Lee, A, Osborne, J, Zullo, T, and Murry, T (2004). Development and Validation of the Voice Handicap Index- 10. Laryngoscope: 114(9): 1549-1556
Eating Assessment Tool - EAT-10 - For people with Swallowing
Problems (Dysphagia)

Circle the appropriate response 0 = No problem 4 = Severe problem

1. My swallowing problem has caused me to lose weight.                          0 1 2 3 4
2. My swallowing problem interferes with my ability to go out for meals.     0 1 2 3 4
3. Swallowing liquids takes extra effort.                                                      0 1 2 3 4
4. Swallowing solids takes extra effort.                                                       0 1 2 3 4
5. Swallowing pills takes extra effort.                                                          0 1 2 3 4
6. Swallowing is painful.                                                                              0 1 2 3 4
7. The pleasure of eating is affected by my swallowing.                             0 1 2 3 4
8. When I swallow food sticks in my throat.                                                 0 1 2 3 4
9. I cough when I eat.                                                                                 0 1 2 3 4
10. Swallowing is stressful.                                                                         0 1 2 3 4

If your EAT-10 score is 3 or higher, we recommend a consultation with Dr. Zalvan to help diagnose a swallow
problem and find a solution to your issue.

Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, and Leonard RJ. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 117: 919-924, 2008.
Cough Severity Index (CSI)

Circle the appropriate response 0 = No problem 4 = Severe problem

1. My cough is worse when I lie down.                                                                  0 1 2 3 4
2. My coughing problem causes me to restrict my personal and social life.         0 1 2 3 4
3. I tend to avoid places because of my cough problem.                                     0 1 2 3 4
4. I feel embarrassed because of my coughing problem.                                     0 1 2 3 4
5. People ask, ‘‘What’s wrong?’’ because I cough a lot.                                       0 1 2 3 4
6. I run out of air when I cough.                                                                            0 1 2 3 4
7. My coughing problem affects my voice.                                                            0 1 2 3 4
8. My coughing problem limits my physical activity.                                              0 1 2 3 4
9. My coughing problem upsets me.                                                                     0 1 2 3 4
10. People ask me if I am sick because I cough a lot.                                           0 1 2 3 4

Any score can be considered abnormal as this is based on your symptoms. This subjective index is useful for
following results of treatment. Contact Dr. Zalvan for an appointment to discuss and evaluate the possible causes
of your cough, especially if you have had multiple treatments and consultations for your cough.


Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway. Laryngoscope.  2013; 123(8):1931-6 (ISSN: 1531-4995). Shembel AC; Rosen CA; Zullo TG;
Gartner-Schmidt JL