Are you congested? A comparison of definitions between otolaryngologists and their patients

Jakob L. Fischer, Anthony M. Tolisano, Alvaro I. Navarro, Lily Trinh, Waleed M. Abuzeid, Ian M. Humphreys, Nadeem A. Akbar, Sharan Shah, John S. Schneider, Charles A. Riley, Edward D. McCoul

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Objective: To assess for differences of intended meaning in the description of congestion-related symptoms among otolaryngology patients and clinicians. Materials and Methods: Between June 2020 and October 2022, a questionnaire consisting of 16 common descriptors of congestion-related symptoms within four domains (obstructive-related, pressure-related, mucus-related, and other symptoms) was completed by patients and otolaryngologists at five tertiary otolaryngology practices. The primary outcome was to assess differences in patient and clinician perceptions of congestion-related symptoms. Differences based on geographic location was a secondary outcome. Results: A total of 349 patients and 40 otolaryngologists participated. Patients selected a median of 6.8 (standard deviation [SD] 3.0) terms compared with 4.0 (SD 1.6) terms for otolaryngologists (p < 0.001). Otolaryngologists were more likely to select obstruction-related symptoms (difference 6.3%; 95% confidence interval [CI] 3.8%, 8.9%). Patients were more likely to describe congestion using pressure-related (−43.7%; −58.9%, −28.5%), mucus-related (−43.5%; −59.3%, −27.8%), and other symptoms (−44.2; −51.3%, −37.1%) compared with otolaryngologists. There were no significant differences identified based on geographic location with regard to symptom domains on multivariate analysis. Conclusions: There are differences between otolaryngologists and their patients in the interpretation of the symptoms of congestion. Clinicians tended to have a narrower interpretation of congestion that was limited to the obstruction-related symptom domain, while patients defined congestion more broadly. This has important counseling and communication implications for the clinician.

Original languageEnglish
Pages (from-to)86-95
Number of pages10
JournalInternational Forum of Allergy and Rhinology
Issue number1
StatePublished - Jan 2024


  • congestion
  • definition of terms
  • health literacy
  • nasal obstruction
  • patient–provider communication
  • symptom
  • word association


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