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Reflux Symptom Index

The Reflux Symptom Index (RSI) is a validated, patient-reported questionnaire designed to assess the severity of symptoms associated with laryngopharyngeal reflux (LPR). Unlike gastroesophageal reflux disease (GERD), which typically presents with heartburn, LPR symptoms often include hoarseness, throat clearing, cough, and the sensation of a lump in the throat. Accurate diagnosis of LPR can be challenging, making semi-quantitative tools like the Reflux Symptom Index valuable for both screening and monitoring treatment progress.

Developed and validated by Belafsky et al. in 2002, the RSI provides a standardized method for evaluating LPR symptoms and guiding clinical decision-making. Patients complete the Reflux Symptom Index by rating their symptoms on a scale from 0 (no problem) to 5 (severe problem), resulting in a total score that helps clinicians determine the likelihood and severity of reflux-related issues. A higher score suggests more significant symptoms and may prompt further diagnostic evaluation or therapeutic intervention. This tool is quick to administer and non-invasive, making it a standard component of clinical practice for otolaryngologists, gastroenterologists, and speech-language pathologists.

Reflux Sympton Index Chart

Within the last month, how did the following problems effect you?

0 = No problem

5 = Sever problem

Value

A total score greater than 13 is generally considered abnormal and suggests significant reflux symptoms that may require further evaluation or management.

Reflux Sympton Index Chart

Reflux Symptom Index Questionnaire

Patients rate each symptom from 0 (no problem) to 5 (severe problem) based on its severity over the past month, with a maximum total score of 45.

1. Hoarseness or voice problems
2. Throat clearing
3. Excess mucus or postnasal drip
4. Difficulty swallowing
5. Coughing after eating or lying down
6. Breathing difficulties or choking episodes
7. Troublesome cough
8. Sensation of something sticking in the throat
9. Heartburn, chest pain, indigestion, or stomach acid coming up

Reflux Symptom Index Scoring & Interpretation of Results

The total Reflux Symptom Index score provides clinical insight into the likelihood and severity of laryngopharyngeal reflux. A total score greater than 13 is generally considered abnormal and suggests significant reflux symptoms that may require further evaluation or management. This threshold, established by Belafsky et al. in 2002 through comparison of healthy controls and LPR patients, optimizes sensitivity and specificity for clinical use.

Lower scores typically indicate minimal or no clinically relevant symptoms. Clinicians should use the Reflux Symptom Index score in conjunction with physical examination and additional diagnostic tests when necessary. Tracking the Reflux Symptom Index over time can also help monitor a patient’s response to treatment and guide adjustments in therapy.

Learn more on the BackTable ENT Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on the Reflux Symptom Index and how to build your practice by listening to the BackTable Podcast.

Ep 175 Understanding Atypical LPR: Beyond the Larynx with Dr. Inna Husain

00:00 / 01:04

References

[1] Belafsky, P. C., Postma, G. N., & Koufman, J. A. "Validity and reliability of the reflux symptom index (RSI)." Journal of Voice, 2002;16(2):274–277.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.