In world's 1st known case, man tears windpipe from holding sneeze

An X-ray of the man's neck revealed that he had pockets of air trapped underneath the skin of his neck, as shown by the arrows above.  (Image credit: BMJ Case Reports 2023)

In the first known case of its kind, a man tore a small hole in his windpipe after attempting to hold in a sneeze. 

The odd event occurred while the man was driving his car and experiencing a bout of hay fever. He suddenly felt the overwhelming urge to sneeze, but instead of letting the sneeze loose, he stifled it by pinching his nose and closing his mouth. 

If during a sneeze, the mouth and nose are both closed, the pressure generated in the upper airways can exceed more than 20 times that which would normally build up during a sneeze. In the man's case, the pressure was so great that he tore a 0.08 inch by 0.08 inch (2 by 2 millimeter) hole in his windpipe. 

When the man arrived at the emergency department, he was in severe pain, his neck was swollen on both sides and he struggled to move it. When doctors examined it, they could also hear a faint crackling sound. However, the man didn't have any issues breathing, swallowing or talking. 

Related: A man's voice grew hoarse for no obvious reason. It turns out, he had fungus in his throat.

A neck X-ray revealed that the man had surgical emphysema, a condition in which air gets trapped under the deepest tissue layers below the skin. A computed tomography (CT) scan then showed that the tear was between the third and fourth bones, or vertebrae, of his neck. Air had also accumulated in the space in the chest between his lungs

Doctors concluded that the tear was caused by a "rapid build-up of pressure in the trachea while sneezing with a pinched nose and closed mouth."

Physicians ruled that the man didn't need surgery. However, he was monitored at the hospital for two days to ensure his oxygen levels and other vital signs stayed steady. He was then discharged, armed with pain-relief and hay-fever medications. His doctors also told him not to do any strenuous physical activity for two weeks. 

Five weeks later, a CT scan revealed that the tear had completely healed. 

Ultimately, the man endured fairly minor injuries. But doctors involved in his case, described in a report published Dec. 1 in the journal BMJ Case Reports, said it should be a warning to others. 

"Everyone should be advised not to stifle sneezes by pinching the nose while keeping the mouth closed as it can result in tracheal [windpipe] perforation," the case report authors wrote. 

Spontaneous tearing of the windpipe is rare but potentially deadly. Only a few cases have ever been reported, and they're usually caused by physical trauma or injuries following a medical procedure, such as surgical removal of the thyroid gland or insertion of a tube into the windpipe. Depending on where the tear is and whether a patient's vital signs are stable, surgery is usually needed to repair the damage, the case report authors wrote.

Sustaining such injuries from holding in a sneeze is, of course, very rare — but apparently not impossible. 

This article is for informational purposes only and is not meant to offer medical advice.

Ever wonder why some people build muscle more easily than others or why freckles come out in the sun? Send us your questions about how the human body works to with the subject line "Health Desk Q." 

Emily Cooke
Staff Writer

Emily is a health news writer based in London, United Kingdom. She holds a bachelor's degree in biology from Durham University and a master's degree in clinical and therapeutic neuroscience from Oxford University. She has worked in science communication, medical writing and as a local news reporter while undertaking journalism training. In 2018, she was named one of MHP Communications' 30 journalists to watch under 30. (