THE ST GEORGE HOSPITAL Sydney Swallow Questionnaire THE UNIVERSITY OF NEW SOUTH WALES DEPARTMENT OF GASTROENTEROLOGY Name: DOB/Sex: Date: This questionnaire is designed to help us establish the severity.

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How to fill out the Sydney Swallow Questionnaire online

The Sydney Swallow Questionnaire is designed to assess the severity of swallowing difficulties. This guide will provide you with comprehensive instructions on how to fill out the questionnaire online, ensuring that you can complete it easily and accurately.

Follow the steps to complete the Sydney Swallow Questionnaire online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering your name in the designated field to identify your responses.
  3. Provide your date of birth and sex in the corresponding fields to assist in the assessment.
  4. Answer the first question regarding your overall difficulty swallowing by placing an 'X' on the scale provided.
  5. Continue with the subsequent questions about swallowing different types of liquids and foods by marking 'X' according to your level of difficulty.
  6. For questions about the sensation of food getting stuck or coughing while swallowing, choose the option that best reflects your experience.
  7. Indicate the time it takes you to eat an average meal by ticking one of the provided options.
  8. For the final questions, rate the severity of your swallowing problem and how it interferes with your quality of life.
  9. Once you have completed all sections, review your responses for accuracy.
  10. Save your changes, then download, print, or share the questionnaire as needed.

Complete the Sydney Swallow Questionnaire online today for a better understanding of your swallowing difficulties.

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What is Sydney Swallow questionnaire?

Background: The Sydney Swallow Questionnaire (SSQ) is a self-report inventory assessing subjective symptoms of oropharyngeal dysphagia with strong content, construct, discriminant, and predictive validity and test-retest reliability in a range of patient populations.

A videofluoroscopy assesses your swallowing ability. It takes place in the X-ray department and provides a moving image of your swallowing in real time. You'll be asked to swallow different types of food and drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays.

The Sydney Swallow Questionnaire (SSQ) is a 17 question, self-report inventory, which was developed to measure symptomatic severity of oral-pharyngeal dysphagia as reported by the affected patient. The questionnaire uses a 100mm long visual analogue scale (VAS) for all but one question.

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