Why You Shouldn’t Hold in a Sneeze

We’ve all been in there. Maybe it’s a religious service, a crowded elevator during a pandemic, or your boss is giving a big presentation. In any event, silence is a virtue — as is keeping your germs to yourself. But our bodies don’t always comply with our environments. When your nose feels that tickle to tell you a sneeze is coming, you do whatever you can to prevent yourself from making a loud noise, drawing attention to yourself. After all, it’s only a sneeze — it isn’t worth the embarrassment, right?

Well — maybe it is.

In 2019, a team of researchers led by Wandling Yang, an ear-nose-throat doctor at the University Hospitals of Leicester published a paper titled “Snap, crackle and pop: when sneezing leads to crackling in the neck.” And by “crackling,” they mean something called “spontaneous perforation of the pharynx,” which sounds scary — because it is. It means you’ve blown a small hole in your throat. And that’s not a great idea, even if smaller perforations usually heal over time without surgery. 

Throat holes like this often occur for no obvious rhyme nor reason, hence the word “spontaneous” before the name of the condition. But sneezing — or, more correctly, needing to sneeze and not (which I originally typoed as “needing to sneeze and snot”) — can definitely be a cause, as Dr. Yang and team concluded. In their paper, they shared the story of a 34-year-old British man who, per Smithsonian, “when he felt [a sneeze] coming on, he had pinched his nose closed and squeezed his mouth shut.” (As Dr. Yang told CNN, the man was a habitual sneeze-delayer; “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,” she said.)

But, ultimately, this sneeze came out — and it was bad news for our 34-year-old anti-sneezers. Smithsonian continues: “when the inevitable blast came, he experienced a popping sensation in his neck. A couple of hours later he began experiencing some pain, swelling and a voice change.”  That’s unusual, but it’s not unheard of — as “holding in a sneeze greatly increases pressure inside the respiratory system to a level of about 5 to 24 times that caused by the sneeze itself,” per Healthline, you’re unsneezed tickle can literally blow your throat open.

And it’s not the only damage a held-back sneeze can do to your body. CNN futher explains:

When you sneeze, it’s your body’s protective reflex to get rid of an irritant that has gotten into your nose. With a sneeze, a significant amount of air pressure builds up in the lungs and forces its way through the nasal cavity to get rid of that irritant.

A sneeze can propel mucous droplets at a rate of 100 miles an hour. If you hold a sneeze back, that pressurized air will need to go somewhere. In this case, it injured the tissue in the man’s throat. In past cases, doctors have also seen a stifled sneeze cause sinus problems, middle and inner ear damage, ear infections, and a ruptured eardrum.

And really, as embarrassing as it would be to sneeze during a moment of quiet, it’s probably a lot more embarrassing to require an ER visit because you held in a sneeze, right? (Note that the 34-year-old British man in Dr. Yang’s paper is unnamed..) So you are probably better served by just letting that sneeze fly — but still, be sure to cover your mouth and nose when you do.

Bonus fact: If you tend to sneeze a lot after eating dark chocolate, you’re not alone. As Genome Alberta explains on its blog, about 25% of the population carries a chromosome that causes them — and you — to feel the need to sneeze shortly after enjoying dark chocolate. You’re not allergic to chocolate, though; other than the sneezing, there’s no evidence of any other chocoate-causing issues among those with this chromosome.

From the Archives: The Surprising Story Behind the Sound of Sneezes: When we sneeze, we all make an achoo sound (or something like it), right? Wrong. Some people don’t, and the reason they don’t suggests the rest of us don’t have to.