DOV Questionnaire v2

This questionnaire is to assess for Dysphagia, Odynophagia and Voice (DOV). Dysphagia is difficulty swallowing meaning that it may take longer to finish meals or consume foods with certain textures. Odynophagia is pain with swallowing meaning that eating might cause pain requiring meals to be smaller. The voice component evaluates difficulty speaking loudly and clearly.

1. Swallowing (pick the single best answer)

I do not have any difficulty swallowing.I can swallow all types of food without choking, but meals require extra time.I can swallow solids, but clear liquids (such as water) make me choke.I can swallow soft foods (oatmeal, pudding), but I choke on liquids and solid foods (meat)I choke when eating or drinking any type of food.

2. Voice (pick the single best answer)

My voice is strong and clear all day long.My voice is hoarse, but people can hear me even in a noisy environment.My voice is hoarse and people can hear me only in a quiet environment.My voice is usually too weak to talk with others.

3. Pain with Swallowing (pick the single best answer)

I have no pain with swallowing any type of food.I have mild pain with swallowing, but can eat anything I want.I have moderate pain with swallowing and usually cannot finish a normal meal.I have severe pain with swallowing and can only eat or drink limited foods like ice cream or pudding.