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January 17, 2018

Why you shouldn't hold in your sneeze: A cautionary tale

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Mar. 17, 2022.

    A 34-year-old, "previously fit" man was hospitalized with a perforated throat after attempting to hold in a sneeze, according to a case report in BMJ Case Reports—and experts say it should serve as a cautionary tale to other sneeze-stiflers.

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    How a sneeze led to a hospital stay

    According to the case report—titled, "Snap, crackle, and pop: When sneezing leads to crackling in the neck"—the unnamed patient felt a popping sensation in his neck after he tried to hold in a "forceful" sneeze by covering his nose and mouth. However, he didn't seek out medical attention until later, after he experienced pain and swelling around his neck and had difficulty speaking.  

    Wanding Yang, an author on the case report, said, "This 34-year-old chap said he was always trying to hold his sneeze because he thinks it is very unhygienic to sneeze into the atmosphere or into someone's face. That means he's been holding his sneezes for the last 30 years or so, but this time it was different."

    After assessing the swelling and hearing popping noises while examining the soft tissue of the man's neck, doctors determined that there were likely air bubbles seeping into the man's neck muscle and tissue. After doing some CT scans, they confirmed the diagnosis—the built-up pressure from his sneeze went through the soft tissue in his throat, ruptured the pharynx, and caused air bubbles to form in his neck tissue.

    In other words, according to the case report, the patient had ripped a small hole in his throat by stifling his sneeze. "Luckily, it was a very small perforation," Yang said. "He didn't need any operation."

    Fearing that an infection could form within his neck, doctors placed the man on a feeding tube and a regimen of antibiotics. The doctors removed the feeding tube after about seven days, when the swelling had faded, and the man was transitioned to soft foods and further rest. When he returned for a two-month checkup, he was fully recovered.

    Why you should never hold in a sneeze

    According to Adam Klein, the director of the Emory Voice Center and the chief of the division of laryngology in the department of otolaryngology, this kind of injury from stifling a sneeze is rare. "It is a rare injury that we would more likely see with trauma, like if someone were to be in a car accident or was injured with a gunshot or knife, or if they swallowed something sharp," he said.

    However, that doesn't mean that holding in a sneeze is without potentially serious consequences. According to the Cleveland Clinic, a sneeze can propel mucus at a rate of 100 mph—so trying to stifle a sneeze means the pressured air will try to escape by some other means. Michael Benninger, an otolaryngologist and chair of the Clinic's Head and Neck Institute, said, "It's like forcing water through a pipe. If the air can escape through your nose and mouth, that creates less pressure than forcing it through a smaller opening."

    In the latest case report, the blocked sneeze caused a neck injury—but doctors said they have seen a variety of injuries resulting from someone trying to stifle a sneeze. "I've seen patients with a ruptured eardrum or pulled back muscles, and you hear about cracked ribs," Benninger said.

    Moreover, experts say people who stifle sneezes leave in their bodies irritants that the body is trying to evict—which means you could end up spreading an infection within your body. According to Rachel Szekely, an immunologist at the Clinic, "By stifling a sneeze, you could push infected mucus through the eustachian tube and back into the middle ear. You can get middle ear infections because of that."

    The researchers advised people to let themselves sneeze fully, using a tissue or the crook of their arm to curb the spread of germs. But they reiterated their advice against stifling a sneeze, concluding, "Halting sneeze via blocking nostrils and mouth is a dangerous maneuver" that "should be avoided, as it may lead to numerous complications" (Christensen, CNN, 1/16; Andrews, Washington Post, 1/16; Welch, CBS News, 1/15; Carroll, "Today," NBC, 1/16).

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