Survey Type
Do you have dysphagia?
Take the test to find out!
EAT-10: A Swallowing Screening Tool
OBJECTIVE:
EAT-10 helps to measure swallowing difficulties.
It may be important for you to talk with your physician about treatment options for symptoms.
A. INSTRUCTIONS:
Answer each question by writing the number of points in the boxes.
To what extent do you experience the following problems?
CoMiSS: Cow’s Milk-related Symptom Score
| Last name | First name | |
| Age | Date | |
OBJECTIVE:
EAT-10 helps to measure swallowing difficulties.
It may be important for you to talk with your physician about treatment options for symptoms.
| Symptom | Score | |
|---|---|---|
| My swallowing problem has caused me to lose weight. |
Text Answer
|
0
|
| My swallowing problem interferes with my ability to go out for meals. |
Text Answer
|
0
|
| Swallowing liquids takes extra effort. |
Text Answer
|
0
|
| Swallowing solids takes extra effort. |
Text Answer
|
0
|
| Swallowing pills takes extra effort. |
Text Answer
|
0
|
| Swallowing is painful. |
Text Answer
|
0
|
| The pleasure of eating is affected by my swallowing. |
Text Answer
|
0
|
| When I swallow food sticks in my throat. |
Text Answer
|
0
|
| I cough when I eat. |
Text Answer
|
0
|
| Swallowing is stressful. |
Text Answer
|
0
|
| Final result | 0 | |
SCORING:
Add up the number of points and write your total score in the boxes.
Total Score (max. 40 points)
Reference: The validity and reliability of EAT-10 has been determined.
Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and Reliability of the Eating Assessment Tool (EAT-10). Annals of Otology Rhinology & Laryngology 2008;117(12):919-924.
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