A sneeze, known medically as sternutation, is an involuntary, rapid reflex designed to forcibly clear irritants, like dust or foreign particles, from the nasal passages. This protective mechanism involves a deep breath followed by a powerful, explosive exhalation. The air expelled during a typical sneeze can travel at velocities up to 100 miles per hour. The force behind this reflex is substantial, acting as a natural cleansing system for the upper respiratory tract.
Consequences for the Throat and Sinuses
When a sneeze is suppressed by pinching the nose and closing the mouth, the immense pressure generated has nowhere to go but inward. This maneuver can increase the internal air pressure by five to 24 times compared to a normal, open sneeze. The trapped, high-pressure air is then redirected into the adjacent anatomical structures of the head and chest. This sudden, excessive pressure can cause barotrauma, which is physical damage to tissues caused by pressure differences.
One of the most severe, though rare, reported injuries is the spontaneous perforation of the pharynx (throat). In documented cases, individuals attempting to stifle a sneeze experienced a popping sensation in the neck, confirmed to be a tear in the throat tissue. The displaced air can also lead to pneumomediastinum, a condition where air escapes into the deep tissues of the neck and chest.
Less dramatically, the sudden pressure spike can rupture tiny blood vessels in the face or eyes, leading to small red spots known as petechiae. The forced backward movement of air and mucus can also push bacteria and irritants deeper into the sinus cavities, potentially causing infections.
Damage to the Ears
The auditory system is also susceptible to damage when a sneeze is held in because the ears, nose, and throat are interconnected. The Eustachian tubes link the nasopharynx to the middle ear space, where they are normally responsible for equalizing pressure on both sides of the eardrum.
When the explosive force of a suppressed sneeze is contained, the air pressure is driven up the Eustachian tubes toward the middle ear. This sudden burst of air can exert extreme force on the delicate tympanic membrane (eardrum). The pressure may cause the eardrum to bulge outward or, in rare instances, to rupture.
The pressure can be transmitted further into the inner ear, potentially creating an implosive fistula in the oval or round window. Such inner ear damage can result in temporary or permanent sensorineural hearing loss or trigger vertigo.
How to Sneeze Safely
Allowing a sneeze to exit the body naturally is the safest approach, ensuring the pressure is released outward rather than redirected internally. The most effective way to manage a sneeze is to let the reflex complete while minimizing the spread of airborne droplets.
The recommended hygienic practice is to sneeze into a tissue, disposing of it immediately after use. If a tissue is unavailable, the proper technique is to turn your head and sneeze into the crook of your elbow or upper sleeve. This method prevents the high-velocity spray of respiratory droplets from contaminating your hands or the surrounding environment. Under no circumstances should you attempt to pinch your nose closed or clamp your mouth shut to stop the sneeze mid-action.