Copy of Efficacy of Reflux Stop (Female)
1.
Please indicate below any symptoms you regularly experienced
before
your intervention
THROAT: Hoarseness, sore throat, loss of voice or throat clearing
CHEST: Chronic cough or asthma like symptoms
NOSE: Post nasal drip, poor sense of smell, sinustitis or catarrhal symptoms
THROAT: Globus (feeling of lump in the throat)
MOUTH: Tooth erosion
MOUTH: Bad breath or bad taste in mouth
EYES: Dry or gritty eyes
EARS: Waxing, Glue Ear, Tinnitus or dizziness
2.
Please indicate below any symptoms you regularly experienced
after
your intervention.
THROAT: Hoarseness, sore throat, loss of voice or throat clearing
CHEST: Chronic cough or asthma like symptoms
NOSE: Post nasal drip, poor sense of smell, sinustitis or catarrhal symptoms
THROAT: Globus (feeling of lump in the throat)
MOUTH: Tooth erosion
MOUTH: Bad breath or bad taste in mouth
EYES: Dry or gritty eyes
EARS: Waxing, Glue Ear, Tinnitus or dizziness
3.
How long ago did you have your surgery?
Within the last 6 months
6 months to a year
More than a year
4.
Are you happy you had the treatment?
Yes
No