Sneezing is an astoundingly powerful human action, blasting mucus and air from the nose and mouth at up to 100 miles per hour, according to the Cleveland Clinic. That power exists whether a sneeze is held in or not.
"Occasionally, people will cause some damage to their eardrums or their sinuses if they stifle a very violent sneeze," Rachel Szekely, an immunologist at Cleveland Clinic, said in an article urging people to sneeze freely and not to hold back posted on the health provider's website.
A healthy 34-year-old man living in the United Kingdom learned that the hard way, according to a case study published Monday in the British Medical Journal. His attempt to stifle a sneeze backfired, and the force of that would-be sneeze tore through the soft tissue in his throat, rupturing part of it.
The study — "Snap, crackle and pop: when sneezing leads to crackling in the neck" — described the man, whom it did not identify, as "previously fit and well." One day, he felt a sneeze forming, so he did what he often did: tried to stop it. He clamped one hand over his mouth while pinching his nose.
"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," case report author Wanding Yang told CNN.
While trying to hold back the sneeze, he felt a "popping sensation" in his neck, which began to swell. His voice also changed.
Doctors asked if he had "eaten anything sharp," which he denied.
Subsequent X-rays showed that the built-up pressure from the sneeze, which needed to escape his body somehow, tore through the throat's soft tissue when its preferred exit — his nose and mouth — were blocked. It ruptured the pharynx, the membrane-filled cavity connecting the mouth and nose with the esophagus. It also caused air bubbles to form in his neck's soft tissue, which caused the popping sensation.
Fearing that a deep neck infection could form, doctors hospitalized the man, who was given a feeding tube and put on a regimen of antibiotics. He was released a week later, after the wounds in his neck healed.
Sneezing is the body's way of ridding itself of potentially harmful irritants in the nose, throat or lungs. Pressure builds up in the lungs and then forcefully explodes up the esophagus and out of the nose and mouth. But if those orifices are blocked, the pressure needs to escape somehow.
"It's like forcing water through a pipe," Michael Benninger, an otolaryngologist and chairman of the Head and Neck Institute at Cleveland Clinic, told Time magazine in 2015. "If the air can escape through your nose and mouth, that creates less pressure than forcing it through a smaller opening."
While complications from stifling sneezes are rare, they can be dangerous, the case study noted.
"I've seen patients with a ruptured eardrum or pulled back muscles, and you hear about cracked ribs," Michael Benninger, an otolaryngologist and chairman of the Head and Neck Institute at Cleveland Clinic, told Time magazine in 2015.
The other fallout from stifling sneezes is that the body doesn't rid itself of the irritant, which is usually a mucus discharge. That mucus has to go somewhere.
"By stifling a sneeze, you could push infected mucus through the eustachian tube and back into the middle ear," Szekely said in the Cleveland Clinic article. "You can get middle ear infections because of that."