Forceful Sneeze Leads to Rare, but Serious Injury

This case involves a male's spontaneous perforation of the pyriform sinus after a forceful sneeze
This case involves a male's spontaneous perforation of the pyriform sinus after a forceful sneeze

Blocking the nostrils and mouth during a sneeze can lead to a dangerous situation, according to a new case published in BMJ Case Reports

The case involved a 34-year-old male who suffered a spontaneously perforated pharynx after he tried to halt a sneeze. Doctors were surprised when the man entered the emergency department with a rupture at the back of his throat, as this usually occurs from trauma, retching or heavy coughing. The man reported that he felt a popping sensation in his neck which began to swell after he had suppressed a sneeze by pinching his nostrils and keeping his mouth closed; he later found it very painful to swallow.

Examination revealed crepitus in both sides of the anterior neck extending down to the sternum, indicating that air bubbles had gotten into deep tissue and chest muscles. A neck radiograph confirmed air in the retropharyngeal region and a computed tomography (CT) with contrast showed extensive soft tissue emphysema predominantly centered within the neck. The air collections were determined to be a result of a pharyngeal tear possibly from the right pyriform sinus.

The patient was admitted and treated with enteral feeding and prophylactic intravenous antibiotics. Seven days later, a repeat CT scan found substantially subsided soft tissue emphysema. A soft diet was started without any issues and the patient was subsequently discharged; a 2-month follow-up found no further complications or recurrence.

Early diagnosis of pharyngeal perforation can be difficult. The authors write that “CT scan of the neck and thorax with water-soluble contrast swallow should be used as the gold standard investigation which can confirm the diagnosis and defines the exact pathological site.”

They conclude by stating that, “Halting a sneeze via blocking nostrils and mouth is a dangerous maneuver and should be avoided, as it may lead to numerous complications such as pneumomediastinum, perforation of tympanic membrane and even rupture of cerebral aneurysm.” Although spontaneous pharyngeal perforation is a rare occurrence after a forceful sneeze against a closed glottis, clinicians should "maintain a high degree of suspicion and initiate investigation and treatment early to avoid complication." 

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For more information visit BMJ.com.