January 16, 2018 12:30 am
Updated: January 16, 2018 9:57 am

Why holding in a sneeze can be dangerous

Holding in a sneeze can cause injury, experts warn.

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Doctors are warning against holding in your sneezes after a man ruptured the back of his throat when he did so and was hospitalized, a new case study details in the BMJ.

According to the study, the young man (whose identity is protected due to confidentiality purposes) pinched his nose and clamped his mouth shut to hold in a forceful sneeze and ended up causing the injury.

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This left the 34-year-old patient barely able to speak or swallow, also leaving him in considerable pain.

A spontaneous rupture of the back of the throat is rare, the authors say, and is usually a result of trauma. It can also be due to vomiting, retching or heavy coughing.

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So when the man presented himself to emergency room doctors, they were surprised by his symptoms. He said he had developed a “popping sensation” in his neck, which swelled up right after he tried to contain a forceful sneeze.

Not too long after he said he found it extremely painful to swallow. He also was losing his voice.

When doctors looked at him, they too heard the popping noise, as well as some crackling sounds (called crepitus) extending from his neck to his ribcage. This, physicians say, is a sure sign that air bubbles had reached into the deep tissue and muscles of the chest. It was later confirmed by a tomography scan.

The man was then admitted to the hospital as the risk of serious complication was high. He was fed by a tube and given intravenous antibiotics until the swelling went down and the pain had gone.

The patient was well enough to leave the hospital after seven days.

“Halting sneezing via blocking [the] nostrils and mouth is a dangerous manoeuvre, and should be avoided,” the authors warn. “It may lead to numerous complications, such as pneumomediastinum (air trapped in the chest between both lungs), perforation of the tympanic membrane (perforated eardrum) and even rupture of a cerebral aneurysm (ballooning blood vessel in the brain.”

While incidents like these are rare, they’re not unheard of, Dr. Jennifer Anderson, otolaryngologist at St. Michael’s Hospital, says.

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Anderson says she’s seen similar cases like this several times before in patients, even one having slipped a disk in his back from holding in a forceful sneeze.

“The high pressure has to find an exit so if it can’t go out your mouth or nose then it will go out someplace else,” Anderson says. “There was one time where [the patient] got meningitis and we had to go in and repair the leak.”

The way this, or any other injury in the body resulting from a held-in forceful sneeze, happens is because of the air pressure involved and the rise in venous pressure (the average blood pressure within the venous compartment).

This can result in torn muscles in the back or chest wall, conjunctival hemorrhaging (broken blood vessels in the eye), among other injuries, Anderson says.

The act of sneezing, Anderson explains, is a way for your nose – the body’s filter and humidifier – to clean itself.

It’s the first barrier towards foreign things entering the air stream, she explains, which is important to protect. The lining of the nose is specialized and it helps trap larger dirt particles, blocking them from entering the body. Then it also humidifies the air before it enters the lungs.

As to why some people hold in their sneeze, it could be a cultural thing, Anderson speculates. After major health events like SARS, many of us have been taught to sneeze into our sleeves or limit our sneezing. But next time you feel a sneeze coming on, no matter how fast it comes, try your best to let it out, Anderson says.


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