In a case study, doctors at the ENT, head and neck surgery, University Hospitals of Leicester NHS Trust, reported the very unusual experience of a man who ruptured the back of his throat when he tried to stop a sneeze.
They described their initial confusion when the previously healthy man turned up in the emergency room of a Leicester hospital, complaining of swallowing difficulties and “a popping sensation” in his swollen neck. The 34-year-old patient told them his problems started after he tried to stop a forceful sneeze by pinching his nose and closing his mouth. He eventually lost his voice and spent a week in the hospital.
Another physician described the episode as “exceedingly rare” and said the man’s injuries are more commonly associated with trauma. “When you sneeze, air comes out of you at about 150 miles per hour,” said Dr Anthony Aymat, director for ear, nose and throat services at London’s University Hospital Lewisham, who was not involved in the case. “If you retain all that pressure, it could do a lot of damage and you could end up like the Michelin Man with air trapped in your body.”
While examining the sneeze-averse patient, doctors in Leicester heard “crackling in the neck” down to his ribcage, a sign that air bubbles had seeped into his chest. Worried about infection and other possible complications, they admitted him to the hospital, gave him a feeding tube and administered antibiotics.
Dr Zi Yang Jiang, a head and neck surgeon at University of Texas Health Science Centre at Houston, said in the report that he sees one or two cases arising from repressed sneezes each year, making them an “exceedingly rare” occurrence. Jiang said it was bizarre that a single sneeze could generate enough force to cause the kind of physical damage that usually results from trauma, such as a gunshot wound to the neck. A collapsed lung is among the problems that retaining the air from an imminent sneeze can cause, he said.
“The whole point of sneezing is to get something out of your body, like viruses and bacteria, so if you stop that, those may end up in the wrong part of the body,” he said. Jiang said in most cases, the excess air is later absorbed by the body.
The English patient made a full recovery and was advised to avoid plugging his nose while sneezing in the future. Doctors recommend letting sneezes rip into a tissue instead. “The safest thing to do – although it’s not socially acceptable – is just to sneeze loud,” Aymat said.
Spontaneous perforation of the pharynx is an unusual condition. Due to its non-specific presentation and general lack of awareness, diagnosis and intervention may be delayed resulting in potential complications. This case reports a rare spontaneous perforation of the pyriform sinus after a forceful sneeze, leading to cervical subcutaneous emphysema and pneumomediastinum.
Wanding Yang, Raguwinder S Sahota, Sudip Das