Patient Forms & Symptom Scorecards
Complete validated clinical questionnaires prior to or alongside your consultation with Mr Ahmad Hariri. Your results are evaluated securely and sent directly to our medical team.
ETDQ-7 (Eustachian Tube Dysfunction Questionnaire)
Eustachian Tube Dysfunction Questionnaire-7
A validated 7-item clinical questionnaire designed to score the severity of Eustachian tube symptoms.
The Eustachian tube connects the back of your nose to your middle ear. When it does not function properly, pressure builds up causing ear fullness, crackling, muffled hearing, or pain. Completing this questionnaire helps Mr Hariri quantify your ear symptoms prior to or during your consultation.
EAT-10 (Eating Assessment Tool)
Swallowing & Pharyngeal Pouch Clinical Assessment
A validated 10-item clinical questionnaire assessing swallowing difficulty, pharyngeal pouch symptoms, and dysphagia severity.
Swallowing difficulties (dysphagia) can arise from pharyngeal pouch, throat sphincter tightness, or neuromuscular changes. Completing the EAT-10 allows Mr Hariri to objectively quantify your swallowing symptoms pre- or post-operatively.
VHI-10 (Voice Handicap Index-10)
Voice & Dysphonia Severity Scorecard
A validated 10-item questionnaire measuring the physical, functional, and emotional impact of voice disorders.
Voice changes, hoarseness, or vocal strain can significantly impact daily communication. The VHI-10 helps Mr Hariri assess the functional handicap caused by your voice condition.
SNOT-22 (Sino-Nasal Outcome Test)
Chronic Rhinosinusitis & FESS Outcome Scorecard
The gold-standard 22-item questionnaire for evaluating chronic rhinosinusitis symptoms and FESS surgical outcomes.
Sinusitis and nasal polyps can cause nasal blockage, facial pressure, reduced smell, and sleep disturbance. Completing SNOT-22 allows Mr Hariri to track your sinus symptom severity before and after FESS treatment.
Epworth Sleepiness Scale (ESS)
Daytime Sleepiness & Snoring Assessment
A validated 8-item questionnaire measuring excessive daytime sleepiness associated with snoring and sleep apnea.
Loud snoring and sleep-disordered breathing can lead to hidden daytime exhaustion. The Epworth Sleepiness Scale quantifies your likelihood of dozing off during routine daily activities.
STOP-BANG (OSA Risk Assessment)
Snoring & Obstructive Sleep Apnea Screening
An 8-item clinical screening tool evaluating risk factors for Obstructive Sleep Apnea (OSA).
Snoring can be a sign of Obstructive Sleep Apnea. STOP-BANG screens key physical and historical indicators to help Mr Hariri evaluate if home sleep apnea monitoring or surgery is appropriate.
NOSE Scale (Nasal Obstruction Evaluation)
Nasal Airway Obstruction & Septoplasty Scorecard
A validated 5-item questionnaire evaluating the severity of nasal airway obstruction and breathing difficulty.
Deviated nasal septum, enlarged turbinates, or nasal valve collapse cause persistent nasal blockage. The NOSE scale objectively quantifies nasal airway obstruction before and after nasal surgery.
THI (Tinnitus Handicap Inventory)
Validated 25-item Tinnitus Handicap Scorecard
A validated 25-item questionnaire assessing the emotional, functional, and catastrophic impact of ringing in the ears (tinnitus).
Tinnitus can range from mild background noise to severe distress affecting sleep and concentration. Completing THI provides Mr Hariri with an accurate score of your tinnitus handicap.
DHI (Dizziness Handicap Inventory)
Validated 25-item Dizziness & Vestibular Scorecard
A validated 25-item questionnaire evaluating the emotional, physical, and functional handicap caused by dizziness and unsteadiness.
Dizziness, vertigo, and balance disorders affect confidence during movement. Completing DHI allows Mr Hariri to evaluate your vestibular impairment before balance rehabilitation or medical therapy.
Healthcare Data Protection & Legal Disclaimer Notice
All submitted symptom scores are encrypted in transit and securely stored in compliance with UK Data Protection and Caldicott healthcare guidelines. Form completion is intended for existing patients of Mr Ahmad Hariri or those with scheduled consultations to assist clinical evaluation. Completing an online questionnaire does not create a doctor-patient relationship or provide emergency diagnostic services.