Sneezing is not an activity you’d deem particularly risky. This semi-autonomous mechanism of expelling irritants and pathogens is generally just a fairly irritating thing you have to do whilst alive, like tax returns and pretending to enjoy baseball. But sneezing can go a little wrong, and occasionally land the sneezer in hospital.
One review, which looked into case reports in the medical literature from 1945 to 2018, found 52 cases of sneeze-related injuries, mostly in male patients, and with the majority taking place in patients without other exacerbating conditions.
“Sneeze injuries are rare events but can be life-threatening,” the review explains, adding that problems tended to arise where sneezes were suppressed by closing the mouth and nose, resulting in airway pressure up to 24 times more than an unsuppressed sneeze.
“Boyle’s law states the inverse relationship between pressure and volume. During a sneeze, the high volume in the lungs against a closed glottis translates to high pressure as the glottis opens. However, many people do not like sneezing in public, whether due to the disruptive noise, perception of illness, or mere habit,” the team explains of the mechanism.
“While attempting to hold in a sneeze, the intrathoracic pressure gradient does not simply vanish. The pressure is rerouted or transmitted to the soft tissues resulting in a Valsalva maneuver with potential for many of the injuries and complications seen in this review.”
In one particularly grim case, described under the somewhat distressing title “Snap, crackle, and pop: when sneezing leads to crackling in the neck,” a 34-year-old man landed himself in hospital after covering his mouth and holding his nose at the same time during a sneeze, for reasons not disclosed. As he sneezed, the first sign something was wrong was that he experiencing a “popping sensation” in his neck.
As distressing as that sounds, it got worse when he experienced painful swallowing, a pain in his throat, and a “change of voice” following the achoo. Upon examination, it was discovered that his neck down to his ribcage made popping and crackling sounds, a sign that he either had air bubbles inside his deep tissue and muscles or was harboring two-thirds of the Kellogg’s Rice Krispies trio inside his chest cavity.
Figuring that it was more likely the former (known as “Hamman’s sign” or “Hamman’s crunch“, crackling can occur when the heart beats against tissue filled with air) doctors ordered a scan of his soft neck tissue and chest. This soon revealed the problem: during the act of suppressing his sneeze he had ruptured the back of his throat.
The rupture – which is more often caused by blunt neck trauma, profuse vomiting, and heavy coughing – had caused air to leak into the retropharyngeal region (see the arrow in the scan above), causing pain and loss of voice.
Fortunately, the man was able to recover from the sneeze in hospital. He was given a feeding tube and intravenous antibiotics as a precautionary measure. He was later discharged, but not before he was advised to avoid obstructing both his nostrils while sneezing.
“Halting sneeze via blocking nostrils and mouth is a dangerous maneuver and should be avoided. It may lead to numerous complications such as pneumomediastinum, perforation of tympanic membrane, and even rupture of cerebral aneurysm,” the team concluded in their report.
“Spontaneous pharyngeal perforation can rarely occur after a forceful sneeze especially against a closed glottis. We should maintain a high degree of suspicion and initiate investigation and treatment early to avoid complication.”
The report is published in BMJ Case Reports.
Source Link: Hamman's Crunch: A Man Covered His Nose And Mouth Whilst Sneezing And Ended Up In Hospital
