Sub-glottic Stenosis Severity 6 (SSS-6)

How to complete this Questionnaire:

  • Please indicate which of the five responses below best describes your level of breathlessness over the past week.
  • Please circle the response that indicates how frequently you have the same experience.

0 - 4 Rating Scale
0 = Never
1 = Almost never
2 = Sometimes
3 = Almost always
4 = Always

1. Please indicate which of the five responses below best describes your level of breathlessness over the past week.

(Choose only one response out of the five available below).

2. Please tick the box that best matches your breathing these days

(Please select one answer only)

Situation: I have difficulty catching my breath

3. On average during the past week, how much of the time...

(Please select one answer only)

Situation: ..... did you cough?

4. Please mark which option best reflect your voice symptoms/difficulties.

(Please select one answer only)

Situation: My Voice difficulties restrict my personal and social life.

5. On average, during the past week, how limited were your moderate physical activities(such as walking, housework, carrying things) because of your breathing problems:

(Please select one answer only)

6. In general would you say your health is

(Please select one answer only)

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