Achoo! Good that you did so Do not hold back a sneeze, advise doctors

G.S. Mudur, TT,  Jan 15, 2018, New Delhi: Do not try to suppress a sneeze, doctors have cautioned, highlighting the possibility of serious complications from a burst eardrum to a ruptured artery in the brain if one is unlucky.

A team of British doctors has cited the unusual case of a 34-year-old man who suppressed a sneeze by blocking both his nostrils and closing his mouth, only to find himself in intense pain and unable to speak or swallow.

He later described a popping sensation in his neck and some swelling on both sides of the neck, three ear-nose-and-throat specialists at the University Hospitals of Leicester have said.

It turned out that the man had suffered a spontaneous rupture of the pharynx, the area behind the mouth and nose and above the windpipe and the digestive tube, leading to subcutaneous emphysema, a painful condition in which air slips into the skin of the chest wall.

"Halting a sneeze via blocking nostrils and mouth is a dangerous manoeuvre and should be avoided, as it may lead to numerous complications," Wanding Yang, Raghuwinder Sahota and Sudip Das said on Monday in the British Medical Journal Case Reports, a research publication.

They said such complications could include air leaking into the central cavity of the thorax, a perforation of the tympanic membrane (eardrum), or even a stroke caused by the rupture of a cerebral aneurysm, a balloon-like bulge in a diseased artery in the brain.

When the doctors examined the man with a stethoscope, they heard pops and crackles extending from his neck down to his ribcage, an indication that air bubbles had slipped into the deep tissue and muscles of the chest. A computerised tomography scan confirmed this.

The patient was admitted to the hospital, fed by tube and given intravenous antibiotics until the swelling and pain subsided. He was discharged after seven days with advice to avoid obstructing both his nostrils while sneezing. A follow-up after two months did not reveal any recurrence or complications.

"I have never seen a case like this, but it shows that a suppressed sneeze may in rare cases lead to serious complications," said Murundi B. Bharati, head of ear-nose-and-throat surgery at the JSS Medical College and Hospital, Mysore, who was not associated with the Leicester case report.

"Blocking both nostrils and the mouth may lead to an excessive build-up of air pressure against the pharynx, and people with weak pharyngeal walls may be vulnerable to such complications."

The Leicester team said that patients with well-contained air leakages in their chest walls, and no significant complications, might be treated conservatively with intravenous feeding and antibiotics. But if a patient shows signs of sepsis or large perforations, surgical repair may be necessary.

A sneeze is a reflex action, the body's attempt to expel unwanted allergens from the upper respiratory passages. "It is best not to suppress a sneeze," Bharati said.