Is saving face in that big meeting really worth an eye?

By The Nervous Googler
April 24, 2019

The Nervous Googler writes Is It Just Me? for Health.com. She stays up at night searching health questions so you don’t have to. Send her the questions stressing you out at NervousGoogler@health.com.

Is it just me, or is holding in a sneeze dangerous? Am I going to rupture an eardrum? Pop a blood vessel in my eye? Can I safely stop a sneeze?

Recently I found myself in a room full of very serious journalists learning some very serious #science and all of a sudden I had the urge to sneeze.

Not about to be the jerk who disrupts the whole meeting and sprays her germs on everyone else, I did what any self-respecting would-be sneezer would do: I stifled that thing hard.

You’ve probably done it—you either contract your throat to stop a sneeze somewhere in your belly or chest, or you pinch your nostrils closed to keep that offending sneeze rattling around inside your head instead.

And while I am quick to award myself politeness points when I don’t disrupt a fancy meeting or don’t spray sneezejuice on a fellow restaurant-goer, I also wonder if I’m actually doing myself any favors by holding in a sneeze or if I could potentially be engaging in risky sneeze behavior.

So, naturally, I called up some sneeze doctors to find out. I’m sad to say that it turns out—unlike the kind act of, say, holding a door open for a stranger—holding in a sneeze might actually hurt me (and you). There really are some scary-sounding risks of not letting that sneeze rip, although experts promise me they are very, very rare. (I think they could tell I was nervous!)

“Most people in certain social circumstances have held in a sneeze—in the movies, in restaurants, in a meeting—so it’s happening all the time,” Erich P. Voigt, MD, associate clinical professor of otolaryngology-head and neck surgery at NYU Langone Health, assures me. If holding in a sneeze were really that dangerous, more of those people would be ending up in the offices of docs like him, he says. “The risk associated with holding in a sneeze is very low.”

The chance of a sneeze exploding your head is so low, experts don’t even have enough patients to write up scientific studies; instead, they resort to what’re called case reports, which detail just one particular patient’s experience with a suppressed sneeze. “An isolated case report is a rare event,” Dr. Voigt says. “Maybe even less likely than one in a million,” he guesstimates—if you think about how many people are likely to have ever held in a sneeze and never suffered any drawbacks.

But the list of possible consequences is scarier than the trailer for Us. We’re talking: fractured cartilage around your voice box, neck pain, fractures of bones in your face, rupturing of ear drums, hearing loss, ear infections, vertigo, air trapped under a layer of skin, broken ribs, hernias, vision changes, and ruptured aneurysms, says Christopher Chang, MD, a Warrenton, Virginia-based otolaryngologist-head and neck surgeon with Fauquier ENT Consultants. All from a sneeze, nervous friends. (Just last year, you might remember, the internet lost its mind when a 34-year-old man ruptured his throat from holding in a sneeze.)

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Otolaryngologists call a stifled sneeze a “closed-airway sneeze,” Dr. Chang explains. “When a sneeze is initiated, a lot of pressure builds up in your lungs, and the sneeze is let out all at once forcefully,” he says.

He tipped me off to a 2000 report from the journal Clinical Infectious Diseases that found a stifled sneeze can produce up to a whopping 176 millimeters of mercury (mm Hg) of pressure. Don’t ask me to explain why millimeters of mercury is used to measure pressure, but instead compare that to how much pressure is produced when you let a sneeze rip: a measly 4.6 mm Hg. That is a dramatic difference, Dr. Chang confirms, and “when you hold in a sneeze, that pressure has to go somewhere.”

Our bodies are somewhat flexible and stretchy, obvi, so he likens us to soccer balls: “A soccer ball probably won’t pop, but rarely it could, if you exert enough pressure. It can stretch and come back to normal form. Just like a soccer ball, enough pressure could cause damage to the body, but it’s pretty rare.”

Weirder still is that you, the stifler of sneezes, control where that misdirected pressure goes in your body—which could then affect what unsuspecting and undeserving body part ruptures, fractures, or breaks. If you’re a nose pincher, you’re forcing that pressure searching for an “out” hole up into your face, making it more likely to rupture an eardrum or screw with your vision, Dr. Chang says. Someone who closes their throat to trap sneeze pressure in their chest is more likely to deal with a rib fracture or vocal cord damage. The stifled sneeze shifts around your body “depending on where the pressure valve is,” Dr. Voigt says.

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Now feels like the right time to remind you that all of these sneeze-equences are very, very, very rare. But! You might be slightly more at risk if you’ve got an underlying issue like a small hole at the base of your skull (omg), muscle weakness in your throat (um…), or weakness in the lining of your lungs (ack).

If you hold in a sneeze and happen to have one of those concerns, Dr. Voigt says, you might suffer a complication of those conditions—and, worse still, you might not know you have one until a sneeze sends you to the ER.

If you’re in a silent office, an esteemed theatah, a restaurant with another table that is way too close to yours, you might be able to temporarily distract yourself from sneezing in that awkward moment. “Everyone has different little tricks they can do,” Dr. Chang says, whether it’s rubbing or wiping your nose or getting tickled (lol!), Dr. Voigt adds.

That, my nervous friends, was a very long way of getting to my real point: Just let out the damn sneeze (into a tissue or your elbow, preferably). “The general advice is never hold a sneeze in, because bad things could happen—and nothing bad really happens if you sneeze without trying to hold it in,” Dr. Chang says. “But if a sneeze is coming, it’s gonna come,” says Dr. Voigt.

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