Everyone has someone in their life with an obnoxiously loud sneeze that he or she wishes they would at least try to stifle. As it turns out, stifling sneezes by pinching the nose shut with the mouth closed can actually be dangerous.

Doctors at the Department of Head and Neck Surgery at the University Hospitals of Leicester reported a case of a stifled sneeze so violent that it caused spontaneous perforation of the pharynx – an area of the back of throat – leaving its victim barely able to speak or swallow. This type of injury is most often caused by trauma to the back of the throat, which indicates that the forces produced during a ‘held-in’ sneeze can rival those felt in a blunt trauma to the neck. The man suffered from a perforation of his pharynx, more specifically his pyriform sinus, which is at a higher risk of rupture due to the lack of a secondary supportive muscular layer. Upon examination, crackling sounds were heard in the man’s neck all the way down to his ribcage. A CT scan further verified the existence of air bubbles that had penetrated the muscles of the chest, otherwise known as cervical subcutaneous emphysema. Due to risk of infection, the man was admitted to the hospital where he was tube-fed due to the pain associated with swallowing and administered preventative antibiotics.

“He described a popping sensation in his throat followed by neck swelling so severe he could barely talk or swallow”

Other than a blunt trauma to the neck, spontaneous perforation of the pharynx is thought to occur due to a sudden increase in intraluminal pressure in the oesophagus or pharynx. Infrequently it occurs due to forceful coughing or retching and is rarely caused by holding in a sneeze. Increased intraluminal pressure due to pinching the nose shut and closing the mouth during sneezing can also cause rupture of the eardrum – and rupture of cerebral aneurysms in the worst cases! Doctors warn that sneezing in this fashion is dangerous and should not be done. So, think twice before stifling that fifth-in-a-row sneeze or scolding your friend for a loud sneeze as you just may find one of you two in the emergency room.