Differences in the Intended Meaning of Congestion Between Patients and Clinicians | Allergy and Clinical Immunology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
May 30, 2019

Differences in the Intended Meaning of Congestion Between Patients and Clinicians

Author Affiliations
  • 1Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana
  • 2Ochsner Clinical School, University of Queensland, New Orleans, Louisiana
  • 3Department of Otolaryngology–Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
  • 4Associate Editor, JAMA Otolaryngology–Head & Neck Surgery
  • 5Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, Louisiana
JAMA Otolaryngol Head Neck Surg. 2019;145(7):634-640. doi:10.1001/jamaoto.2019.1023
Key Points

Question  Are patients and physicians communicating clearly when discussing the common complaint of congestion?

Findings  In this cross-sectional survey study of 59 clinicians and 226 patients, otolaryngologists often defined congestion in terms of obstructive symptoms, whereas patients often referred to pressure-related or mucus-related symptoms. Patients required a significantly greater number of terms to define congestion compared with otolaryngologists.

Meaning  The findings suggest that congestion is defined in a highly variable fashion and that patients and clinicians generally do not describe congestion using the same terms.


Importance  Disagreement in the presumed meaning of common medical terms may impair communication between patients and caregivers.

Objective  To clarify the intended meaning of the term congestion among otolaryngology clinic patients and to identify discrepancies in definitions between patients and otolaryngologists.

Design, Setting, and Participants  In this cross-sectional survey study from an otolaryngology clinic at an academic center, a semantics-based questionnaire was provided to consecutive new patients during intake for a clinical encounter from December 2016 through February 2017, and to 31 otolaryngologists and 28 nonotolaryngologist physicians in February 2018. Respondent definitions for congestion were selected from a list of 16 proposed terms covering 4 general categories.

Main Outcome and Measures  Symptom categories for term used to describe congestion by patients and clinicians.

Results  Among 226 patient respondents (133 female [58.8%]; mean [SD] age, 54 [15.6] years), the most commonly selected definitions for congestion were from the obstructive (199; 88.1%) and mucus-related (196; 86.7%) symptom categories. More than 1 general category was selected by 208 patients (92.0%), whereas 11 patients (4.9%) described congestion only in terms of mucus-related symptoms. Definitions were limited to upper respiratory tract symptoms by 83 (36.7%) patients and lower respiratory tract symptoms by 2 (0.9%) patients. Among 31 otolaryngologists, congestion was most frequently defined in terms of obstructive symptoms (difference, 11.9%; 95% CI, 7.4%-16.5%). In contrast, patients more often described congestion in terms of pressure-related (difference, 38.8%; 95% CI, 7.5%-70.1%) or mucus-related (difference, 51.2%; 95% CI, 22.6%-79.9%) symptoms. A total of 22 otolaryngologists (71.0%) defined congestion using 1 to 4 symptoms, compared with only 69 patients (30.5%).

Conclusions and Relevance  The definition of congestion appears to be highly variable and ambiguous for many patients. Moreover, the findings suggest that patients and otolaryngologists generally do not describe congestion using the same terms.