Laryngopharyngeal reflux (LPR) affects many patients with throat symptoms such as chronic cough, hoarseness, sensation of a lump in the throat, or swallowing difficulty. For clinicians, having a reliable, practical screening tool is important. The Reflux Symptom Index (RSI) is one such patient-reported questionnaire frequently used to screen for LPR. This article reviews what the RSI is, how it is applied, what recent research says, and the implications for clinical practice.

What Is the Reflux Symptom Index (RSI)?
The RSI is a self-administered questionnaire designed to quantify symptoms commonly associated with LPR. Patients rate items such as throat clearing, postnasal drip sensation, difficulty swallowing food or pills, cough after eating or lying down, and the sensation of a lump in the throat. Scores for each item typically range from 0 (no problem) to 5 (severe problem). Stanford Medicine The total score helps the clinician screen for likely LPR involvement.

Clinical Application and Scoring
Originally developed by Belafsky et al., the RSI was validated in patients with confirmed LPR and showed good reproducibility and validity. Augusta Elsevier Pure Traditional cut-off values (e.g., 13 or higher) have been used to flag probable LPR and guide further testing or treatment. The RSI is often used alongside the Reflux Finding Score (RFS), which rates visual findings on laryngoscopy. For some practices, a simplified (“binary”) version of RSI – converting each item into present/absent – has been studied as a quicker screening alternative.

Validity and Reliability: What Does Research Show?
Most recent psychometric work provides a more nuanced view. For example, a 2020 study by Nacci et al. investigated the RSI’s psychometric properties using optimal scaling techniques. They found both the original and binary versions had good internal consistency (Cronbach’s alpha ~0.84) and comparable discrimination (AUC values) for LPR diagnosis, but both versions tended to overestimate prevalence. The authors suggested revising the RSI to improve sensitivity and specificity: “it would be necessary to think about modifying the original RSI … or to introduce new scores in order to better frame the probably affected LPR patient.” PubMed Earlier data indicated that RSI correlates well with treatment outcomes (e.g., improvement in RSI after PPI therapy), supporting its construct validity. Augusta Elsevier Pure

Current Scale Indexing and Future Directions
For clinicians working in resource-limited settings, RSI remains a fast and affordable screening option. But emerging research suggests the tool may benefit from refinement: adding or revising items to enhance differentiation of LPR vs other throat disorders; refining cut-off scores based on population; incorporating contextual modifiers (e.g., diet, smoking, voice misuse). A recently proposed Revised RSI (R-RSI) has reported promising metrics (sensitivity ~84.5 %, specificity ~81.8 % at cut-off ≥18) in a validation cohort. PubMed These developments point toward more precise future versions of the RSI that can better support clinical decision-making.

Clinical and Health Implications
For speech-language pathologists (SLPs), ENTs and other clinicians, the RSI offers a practical entry point to consider LPR in the differential diagnosis of throat-swallow complaints. Using it enables structured symptom tracking, patient education and monitoring of treatment response. That said, clinicians should recognise its limitations: a high RSI score does not confirm LPR; rather, it suggests further diagnostic consideration. Educating patients on lifestyle and diet modifications (weight‐based, reflux triggers, timing of meals, head elevation, voice hygiene) remains important, and referral for specialist assessment (e.g., pH-impedance, endoscopic exam) may be indicated for complex cases or poor response to treatment.

If you are managing patients with throat, voice or swallowing symptoms and want a structured, evidence-based approach to screening for reflux-related issues, consider how partnering with DiagnosTech FEES can support your practice. Our team offers comprehensive swallowing and airway assessments, integrated with reflux-related symptom tracking and structured clinical reporting. Reach out to discover how our services can enhance both screening and diagnostic workflows.