There are many times when we would rather hold in a sneeze – whilst driving, during an exam, or that deathly quiet important meeting. It turns out, however, that trying to stifle a sneeze may not be the best idea, and a recent case report documents one man who ended up tearing a small hole in his windpipe by doing so.
Experiencing hay fever, the man felt a sneeze coming on whilst driving a car. Rather than letting it loose, he suppressed it by pinching his nose and closing his mouth – understandable given that our eyes usually close when we sneeze, something of a nuisance considering we need them open to drive. Immediately after, however, the man began to experience severe neck pain and swelling.
By the time he got to the emergency department, the pain and swelling were still present, and whilst he had no problems speaking, swallowing, or breathing, he also had a limited range of movement in his neck. When applying pressure to the area, doctors could also hear a slight crackling noise, known as crepitus.
Medical staff then carried out an X-ray, which revealed surgical emphysema; often caused by injury, this is when air enters and gets trapped beneath the skin. A CT scan carried out immediately after uncovered a 2-millimeter long, 2-millimeter wide, 5-millimeter deep (0.08 x 0.08 x 0.2 inch) tear in the man’s windpipe (or trachea).
The incident is thought to be the first known report of this kind of injury, known as spontaneous tracheal perforation, caused by holding in a sneeze. By closing his nose and mouth, it’s thought that the man may have increased the pressure in his upper airways by more than 20 times the normal amount experienced during a sneeze, with the force ripping the small hole in his trachea.
Whilst the man didn’t need surgery and was discharged after two days of observation, with the injury fully healing by follow-up five weeks later, the authors of the case report recommend people take the incident as a warning.
“Everyone should be advised not to stifle sneezes by pinching the nose while keeping the mouth closed as it can result in tracheal perforation,” they wrote.
Although this particular instance of spontaneous tracheal tearing is a first-time observation, it can happen for reasons other than sneezing. Spontaneous tears can occur as a result of physical trauma, either through injury or following surgical procedures. Thankfully though, it’s also very rare, with only a few reported cases.
Still, when you next feel a sneeze coming on, maybe don’t hold it in – the trachea isn’t the only thing that can tear.
The study is published in BMJ Case Reports.