Unusual: he tears his trachea while holding back a sneeze – Featured

2023-12-15 15:20:28

December 15, 2023

Aged around thirty, a man presented to the emergency room in Dundee (Scotland) with a swollen neck and crackles upon palpation. He suffered from a tracheal tear at the level of the third and fourth thoracic vertebrae when he sneezed with his nose blocked and his mouth closed.

A thunderous “sneeze” is always better than a torn trachea. Because holding back a sneeze – mouth closed, nose pinched – is indeed taking a risk, more reckless than one might imagine. This is what doctors at Dundee hospital, in Scotland, have just observed. They described the 1^is December in the medical journal BMJ Case Reports, the case of a man who suffered a perforated trachea following a sneeze; “which, to our knowledge, has never been reported before.”

Swelling and crackles

The patient is a man in his thirties. After holding in a sneeze by holding his nose and keeping his mouth closed, he felt a sharp pain in his neck. The incident occurred while he was driving with his seat belt on. He went to the emergency room at Dundee Hospital on his own. Physical examination showed that her neck was swollen, with slight crackles on palpation. His neck mobility was also reduced.

Endoscopy revealed nothing abnormal in the pharynx and larynx. “Soft tissue x-ray of the neck showed emphysema (swelling due to infiltration) in the neck. CT scan of the chest and neck revealed a 2 mm by 2 mm by 5 mm tear in the trachea at the level of the third and fourth thoracic vertebrae,” detail the authors of the article.

A rapid increase in pressure in the trachea

He was prescribed paracetamol and codeine for pain, as well as medication for allergic rhinitis and nasal congestion. Although the thoracic surgeons considered that no surgical intervention was necessary, the patient remained under observation for 48 hours. “The man returned home with painkillers and treatment for allergic rhinitis. He was recommended not to play sports for two weeks and not to sneeze while holding his nose with his mouth closed. the article states. Five weeks later, a follow-up CT scan showed resorption of the emphysema and a normal trachea.

“We suspect perforation of the trachea due to a rapid increase in pressure in the trachea due to pinched-nose, closed-mouth sneezing,” note the authors. Indeed, during a sneeze, the pressure in the upper respiratory tract rises between 1 and 2 KPa (kilopascal). But the pressure can be multiplied by 20 if the nose and mouth are blocked. Doctors therefore recommend never holding back a sneeze.

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  Source : Misirovs R, Hoey G, Carruthers C, et al, Spontaneous tracheal perforation following a sneeze, BMJ Case Reports CP 2023;16:e255633.

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  Written by : Dorothée Duchemin – Edited by: Emmanuel Ducreuzet

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