Translation and Validation of the Dutch Version of the Reflux Symptom Score (RSS)

Laryngopharyngeal reflux (LPR) has been described as a chronic inflammatory condition with a substantial negative impact on quality of life. The Reflux Symptom Score (RSS) provided a more comprehensive assessment than other questionnaires, as it systematically assessed 22 items across ear, nose, throat (ENT), digestive, and respiratory domains. This study aimed to translate the RSS into Dutch and to evaluate its reliability and validity in a clinical setting.

The RSS was translated through a forward-backward translation method. Forty participants were enrolled: 20 patients with suspected LPR and 20 healthy controls. Reliability was assessed through internal consistency (Cronbach's alpha) and test-retest reliability (14-day interval). External validity was evaluated by correlating RSS scores with the RSI and Voice Handicap Index-Throat (VHI-T). Criterion validity was tested by comparing scores between the patient and control groups.

The Dutch RSS demonstrated high internal consistency (Cronbach's alpha = 0.870) and excellent test-retest reliability (ICC = 0.858). Patients scored significantly higher than controls on total RSS and on Quality of Life (QoL) impact RSS subset (P < 0.001). Multivariable analysis confirmed that the diagnostic power remained sufficient regardless of age and sex. Receiver Operating Characteristic (ROC) analysis identified an optimal clinical cutoff of 31 points, yielding both 90% sensitivity and specificity.

The Dutch RSS was shown to be a reliable and valid instrument for assessing and monitoring symptoms of LPR. The comprehensive nature and high discriminative power of the RSS supported implementation in daily clinical practice for Dutch-speaking patients.