Articles| Volume 16, ISSUE 2, P274-277, June 2002

Download started.


Validity and Reliability of the Reflux Symptom Index (RSI)


      Laryngopharyngeal reflux (LPR) is present in up to 50% of patients with voice disorders. Currently, there is no validated instrument that documents symptom severity in LPR. We developed the reflux symptom index (RSI), a self-administered nine-item outcomes instrument for LPR. The purpose of this investigation was to evaluate the psychometric properties of the RSI. For validity assessment, 25 patients with LPR were evaluated prospectively before and six months after b.i.d. treatment with proton pump inhibitors (PPI). Each patient completed the RSI as well as the 30-item voice handicap index (VHI). For reliability assessment, the study patients were given the RSI on two separate occasions before the initiation of treatment. Normative RSI data were derived from 25 age-matched and gender-matched controls taken from an existing database of asymptomatic individuals without any evidence of LPR. The mean RSI (± standard deviation) of patients with LPR improved from 21.2 (± 10.7) to 12.8 (± 10.0), and the mean VHI improved from 52.2 (± 24.7) to 41.5 (± 25.0) after 6 months of therapy (p = 0.001 and 0.065, respectively). Of the three VHI subscales (emotional, physical, functional), only the functional subscale improved significantly (p = 0.037). Patients who experienced a five point or better improvement in RSI were 11 times more likely to experience a five-point improvement in VHI (95% confidence interval = 1.7, 76.8). For reliability assessment, the first and second pretreatment RSIs were 19.9 (±11.1) and 20.9 (± 9.6), respectively (correlation coefficient = 0.81, p < 0.001). The single-item correlation coefficients ranged from 0.41 to 0.91 (p < 0.05 for all items). The mean pretreatment RSI in patients with LPR was significantly higher than controls (21.2 versus 11.6; p < 0.001). The mean RSI of patients with LPR after 6 months of PPI therapy approached that of asymptomatic controls (p > 0.05). The RSI is easily administered, highly reproducible, and exhibits excellent construct and criterion-based validity.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect



        • Wong RK
        • Hanson DG
        • Waring PJ
        • et al.
        ENT manifestations of gastroesophageal reflux.
        Am J Gastroenrol. 2000; 95: 15-22
        • Koufman JA
        The otolaryngologic manifestations of gastroesophageal reflux disease.
        Laryngoscope. 1991; 101: 1-78
        • Little FB
        • Koufman JA
        • Kohut RI
        • et al.
        Effect of gastric acid on the pathogenesis of subglottic stenosis.
        Ann Otol Rhinol Laryngol. 1985; 94: 516-519
        • Belafsky PC
        • Postma GN
        • Koufman JA
        The validity and reliability of the reflux finding score (RFS).
        Laryngoscope. 2001; 111: 1313-1317
      1. Koufman JA. Laryngopharyngeal reflux is different from classical gastroesophageal reflux disease: current concepts and a new paradigm of airway disease. Chevalier Jackson Lecture 2000, Transactions of the American Broncho-Esophagological Association (in press).

        • Koufman JA
        • Amin MR
        • Panetti M
        The prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders.
        Otolaryngol Head Neck Surg. 2000; 123: 385-388
        • Belafsky PC
        • Postma GN
        • Koufman JA
        Laryngopharyngeal reflux symptoms improve before changes in physical findings.
        Laryngoscope. 2001; 111: 979-981
        • Olson NR
        Laryngopharyngeal manifestations of gastroesophageal reflux disease.
        Otol Clin NA. 1991; 24: 1201-1213
        • Locke GR
        • Talley NJ
        • Weaver AL
        • et al.
        A new questionnaire for gastroesophageal reflux disease.
        Mayo Clin Proc. 1994; 69: 539-547
        • Colwell HH
        • Mathias SD
        • Pasta DJ
        • et al.
        Development of a health-related quality-of-life questionnaire for individuals with gastroesophageal reflux disease: a validation study.
        Dig Dis Sci. 1999; 44: 1376-1383
        • Shaw MJ
        • Talley NJ
        • Beebe TJ
        • et al.
        Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease.
        Am J Gastroenterol. 2001; 96: 52-57
        • Postma GN
        Ambulatory pH monitoring methodology.
        Annals Otol Rhinol Laryngol Suppl. 2000; 184: 10-14
        • Reulbach TR
        • Belafsky PC
        • Blalock PD
        • Koufman JA
        • Postma GN
        Occult laryngeal pathology in a community-based cohort.
        Otolaryngol Head Neck Surg. 2001; 124: 448-450