ETDQ-7 Questionnaire - Ear & Sinus Institute

Eustachian Tube Dysfunction Questionnaire (ETDQ-7)

Below each question, select the rating from 1-7 to best describe how you feel.
The scale ranges from 1 (No Problem) to 7 (Severe Problem). 4 would correspond to a Moderate Problem.

During the past 1 month, how much of a problem was each of the following?

1. Pressure in the ears?

1 - No Problem 2 3 4 - Moderate Problem 5 6 7 - Severe Problem

2. Pain in the ears?

1 - No Problem 2 3 4 - Moderate Problem 5 6 7 - Severe Problem

3. A feeling that your ears are clogged or “under water”?

1 - No Problem 2 3 4 - Moderate Problem 5 6 7 - Severe Problem

4. Ear problems when you have a cold or sinusitis?

1 - No Problem 2 3 4 - Moderate Problem 5 6 7 - Severe Problem

5. Crackling or popping sounds in the ears?

1 - No Problem 2 3 4 - Moderate Problem 5 6 7 - Severe Problem

6. Ringing in the ears?

1 - No Problem 2 3 4 - Moderate Problem 5 6 7 - Severe Problem

7. A feeling that your hearing is muffled?

1 - No Problem 2 3 4 - Moderate Problem 5 6 7 - Severe Problem

Do you get these symptoms in one ear only or both ears?

Left ear only Right ear only Both ears

First Name

Last Name

Email

Phone

Date of Birth