On an otherwise ordinary day in Dundee, Scotland, a man in his 30s stifled a sneeze while driving—and tore a hole in his throat.

He pinched his nose shut, closed his mouth, and felt a sudden explosion of pain. By the time he arrived at the emergency department at Ninewells Hospital, his neck was swollen, stiff, and radiating discomfort. He couldn’t move it properly. Beneath the skin, doctors could hear a faint, unnerving crackling sound.

Scans soon revealed what few physicians had ever seen before: a spontaneous 2-millimeter tear in his trachea. It’s a rare, potentially life-threatening injury—most often seen after traumatic accidents or invasive surgeries. This time, it came from something as benign as suppressing a sneeze.

A Million-to-One Malfunction

Dr. Rasads Misirovs, a physician at the University of Dundee and lead author of the BMJ Case Report documenting the incident, was stunned.

“The patient presenting to hospital with a suddenly swollen neck following sneezes was quite surprising to us,” he told The Guardian. “None of us had come across such presentation before other than holes in windpipes after injuries or complications of operations.”

In medical terms, it’s known as a “spontaneous tracheal perforation”—a tear in the windpipe not caused by blunt trauma, a knife, or a surgical slip, but by pressure alone.

And pressure was indeed the culprit. When both the nose and mouth are sealed during a sneeze, internal pressure in the upper airways can spike by more than 20 times the normal force. This immense force, in rare cases, can rupture delicate tissues.

A CT scan confirmed the damage. Air had escaped through the tear, seeping into tissues in the man’s neck and even into the space between his lungs—a condition called surgical emphysema. “X-ray of the soft tissues of the neck showed air in parts of the neck structures where there should be no air,” Misirovs said. “We did computed tomography… which showed the extent of trapped air in neck and chest tissues and the location of the hole in the windpipe.”

More Than Just an “Achoo”

Though the man didn’t require surgery, his case was treated with urgency. Doctors monitored him in hospital for 48 hours, withheld food initially to reduce strain on his throat, and prescribed medications for pain and hay fever. He was discharged with orders to rest—and to never suppress a sneeze again.

Five weeks later, follow-up scans showed the tear had healed completely.

Still, it was a brush with danger. “The worst-case scenario could be a burst trachea resulting in suffocation,” Misirovs warned. “Or even a bleed in the brain.”

This isn’t the first documented case of such an injury. In 2018, a similar event occurred in Leicester, when another man tore his throat trying to stifle a sneeze. Another similar case was reported in Australia. But cases like this remain vanishingly rare. “It’s like winning a million-pound lottery,” Misirovs said, “a rare but potentially life-changing complication.”

So, why take the chance?

The sneeze reflex evolved for a reason. It’s the body’s natural defense—a rapid expulsion designed to clear out irritants like pollen, viruses, and dust. While it might be inconvenient or embarrassing in public, holding it in could do more than just make your ears pop.

Safer Alternatives and Lessons Learned

That doesn’t mean sneezing without concern for those around you. “We should gently cover the face either with our hand or inner side of elbow,” Misirovs told The BBC. This helps contain droplets and limit the spread of illness.

For those who absolutely must stifle a sneeze, he offers a safer trick: “I personally have used another technique by pressing a thumb on my upper lip, just under the nose, without blocking nasal passages… By leaving nasal passages open, the sneeze can escape if the stifling does not work.”

In 2023, researchers had already cautioned the public about stifling sneezes after analyzing similarly unusual emergency cases. Those earlier warnings, though, didn’t stop this incident from happening.

“Everyone should be advised not to stifle sneezes by pinching the nose while keeping the mouth closed as it can result in tracheal perforation,” the authors of the recent report concluded.