Impact of the below symptoms since the previous month. (Circle the appropriate response)
0=Absent problem 5=Significant problem 0=Absent problem 5=Significant problem 0=Absent problem 5=Significant problem 0=Absent problem 5=Significant problem 0=Absent problem 5=Significant problem 0=Absent problem 5=Significant problem
Hoarseness of voice 0 1 2 3 4 5
Excessive throat clearing 0 1 2 3 4 5
Excess throat mucus or postnasal drip 0 1 2 3 4 5
Difficulty in swallowing solid, liquid foods and tablets 0 1 2 3 4 5
Episodes of cough following eating or lying down 0 1 2 3 4 5
Difficulty in breathing or episodes of choking 0 1 2 3 4 5
Irritable cough 0 1 2 3 4 5
Globus/lump sensation 0 1 2 3 4 5
Heartburn, chest pain, sense of indigestion or reflux of gastric acid 0 1 2 3 4 5