Can a Sinus Infection Cause Chest Congestion?
Yes, a sinus infection can cause cough, which is a prominent respiratory symptom that may be perceived as chest congestion, occurring in 80% of children with acute sinusitis and frequently worsening at night. 1, 2
Understanding the Connection
Direct Respiratory Symptoms from Sinusitis
Cough is one of the most common manifestations of sinusitis, reported in 80% of children with acute sinusitis and recognized as a cardinal symptom in both children and adults. 1
The cough associated with sinusitis frequently worsens at night, which can create the sensation of chest congestion or respiratory involvement. 2
Postnasal drainage is a prominent feature of sinusitis (occurring in both acute and chronic forms), and this drainage of purulent secretions down the posterior pharynx triggers cough and can create chest symptoms. 1, 2
The Sinusitis-Asthma Connection
Acute or chronic sinusitis can initiate or worsen asthma and bronchial hyperresponsiveness, which would manifest as true chest congestion and respiratory symptoms. 1
Sinusitis can trigger asthma through parasympathetic stimulation: stimulated nerves in an infected sinus may result in parasympathetic stimulation to the bronchial tree and smooth muscle contraction, leading to actual lower airway involvement. 3
Chest auscultation and objective measurements of airflow obstruction should be considered in any patient with possible sinusitis and cough, as this represents a clinically significant connection between upper and lower respiratory tract involvement. 1
Clinical Implications
What This Means for Diagnosis
The presence of cough with sinusitis does not necessarily indicate a separate lower respiratory infection—it may be a direct manifestation of the sinus infection itself through postnasal drainage. 1, 2
However, true bronchial involvement can occur, particularly in patients with underlying asthma or reactive airway disease, where sinusitis acts as a trigger. 1, 3
Key Distinguishing Features
If the "chest congestion" is primarily cough triggered by postnasal drainage, this is a typical sinusitis symptom and should resolve with appropriate sinusitis treatment. 1
If there is true bronchospasm, wheezing, or significant lower airway obstruction, this represents sinusitis-triggered asthma and may require additional bronchodilator or anti-inflammatory therapy beyond sinusitis treatment alone. 1, 3
Important Clinical Pitfalls
Don't assume chest symptoms always represent a separate pneumonia or bronchitis—in the context of diagnosed sinusitis, cough and perceived chest congestion are frequently manifestations of the sinus infection itself. 1, 2
Don't overlook underlying asthma—approximately half of patients with sinusitis have marked rhinitis, and the connection between sinusitis and asthma is well-established. 1, 3
Don't forget that vomiting in children with sinusitis often occurs in association with gagging on mucus, which further demonstrates how postnasal drainage creates lower respiratory symptoms. 1