Congestion Might Mean Something Different To You and Your Doctor Interview with:

Edward McCoul, MD, MPH, FACS Associate Professor Director, Rhinology and Sinus Surgery Department of Otorhinolaryngology Ochsner Clinic New Orleans, Louisiana

Dr. McCoul

Edward McCoul, MD, MPH, FACS
Associate Professor
Director, Rhinology and Sinus Surgery
Department of Otorhinolaryngology
Ochsner Clinic
New Orleans, Louisiana What is the background for this study? What are the main findings?

Response: Although the potential for doctors and patients to misunderstand each other has been noted in other areas of medicine, the meaning of the word “congestion” had not previously been the subject of study.  This paper calls attention to the relevance of potential communication gap in otolaryngology.  This is particularly important since congestion is a major diagnostic criteria of sinusitis, which ranks nationwide in the top 5 reasons for clinical encounters year after year.  If a communication gap is evident around this particular term, which is integral to establishing a diagnosis of sinusitis, then the likelihood increases that patients who present with “sinusitis” will be incorrectly diagnosed.

The process of congestion refers to the microscopic accumulation of blood and/or fluid within cells or the spaces between cells in a particular tissue or body part.  When this occurs in the nose, the result is swelling inside the nose, which narrows the space for air to flow.  A patient would perceive this as blockage or obstruction of airflow.  This can be treated with anti-inflammatory medication that reduces swelling.  Medications that clear up mucus generally are not great at reducing swelling.  Many over-the-counter products are available that combine both types of medications, but using those products runs the risk of overmedication, which can have adverse consequences. What should readers take away from your report?

Response: A key message is that the word “congestion” means different things to different people.  Since it is assumed that people want to optimize their changes of improved health, it is in their interest to choose words that are easily understood.  The doctors who participated in this study unanimously included nasal obstruction as one of the key components of the meaning of congestion.   So a safe bet would be to report blockage, obstruction, or stuffiness.  If the complaint is not in fact blockage, then terms like excess phlegm, mucus, or fluid would be preferred.  Other symptoms such as pressure are also fair game, but should not be equated with congestion, at least not in the absence of obstructive symptoms.  Part of this is also incumbent upon clinicians: the should be urged to avoid ambiguous words altogether and elicit clarification when patients use an ambiguous term.


McCoul ED, Mohammed AE, Debbaneh PM, Carratola M, Patel AS. Differences in the Intended Meaning of Congestion Between Patients and Clinicians. JAMA Otolaryngol Head Neck Surg. Published online May 30, 2019. doi:10.1001/jamaoto.2019.1023 

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Last Updated on June 3, 2019 by Marie Benz MD FAAD