The Perils of Sneezing

When saying "achoo" might hurt you.

ByCari Nierenberg<br>abc News Medical Unit
December 15, 2008, 6:10 PM

Dec. 22, 2008&#151; -- It might have been just another summer day at the office. But when Erina Ramly of Chestnut Hill, Mass., felt a tickle in her nose as she headed to the cubicle of a co-worker, she did not imagine that what happened next would lead to excruciating pain.

She let out a sneeze but soon afterward noticed that she couldn't turn her neck to the left or right.

As the pain in her neck worsened, Ramly went to see her doctor. Much to her surprise, she found out she had whiplash. She was given a neck brace to wear and some muscle relaxants for the pain.

In all likelihood, the sudden movement of the sneeze aggravated Ramly's neck muscles, which may have been tight to begin with because her back was feeling stiff.

"It felt really embarrassing, when I had to tell people the story," Ramly said. "You don't expect to get whiplash from sneezing." But her physician told her he had seen it before, and another friend confided that it had happened to her as well.

Although the chances of hurting yourself while sneezing are extremely low, it can and does happen.

And it can happen to the fittest of us. Not one, but two forceful sneezes sent baseball slugger Sammy Sosa's back into spasm right before a game in 2004. Shortly thereafter, the Chicago Cubs outfielder was placed on the disabled list with a sprained ligament in his lower back.

Sneezing is a quick, sudden motion that can aggravate an underlying problem, like neck or back discomfort, explained Dr. Eric Holbrook, co-director of the sinus center at Massachusetts Eye and Ear Infirmary. Given the right set of circumstances, a sneeze has the potential to strain a muscle or pull a ligament.

Traffic fatalities and accidents have also occurred when drivers have turned their head away to sneeze for a split second or have had a sneezing fit.

In November, for example, a Boston man lost control of his pickup truck on a curvy stretch of road adjacent to the Charles River after he reportedly sneezed while behind the wheel. The driver was not hurt during the incident but his vehicle ended up partially submerged in the river.

Other consequences of sneezing don't necessarily lead to injury, but they can be embarrassing. For women who have incontinence, part of the pressure generated during a sneeze might transmit that pressure to the bladder, which may or may not hold, said Dr. Erin O'Brien, a sinus specialist at the University of Iowa Hospitals and Clinics in Iowa City. This can also happen with a strong sneeze during pregnancy.

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Since the average person tends to sneeze roughly 200 times a year, the odds are low of any harm, noted Dr. Michael Benninger, chairman of the head and neck institute at the Cleveland Clinic. "The greatest risk from sneezing is contagiousness, not personal injury," he said.

What You Might Not Know About Sneezing

A sneeze often starts when an irritant enters the nose, whether it's mucus, dust or an allergen, and this stimulates the trigeminal nerve. An area of the brain called the "sneezing center" senses this and triggers a reflex reaction throughout the body. You take a deep breath in from the lungs, your muscles contract, your eyes close and there's a forceful outflow of air from the nostrils and mouth -- it's all intended to expel whatever was irritating your nose.

"Sneezing is a defense mechanism to protect against a foreign body entering," Holbrook said.

Sneezing is also a subject of curiosity among ear, nose and throat physicians, as well as sinus specialists who get their fair share of questions and hear many old wives' tales about it.

For example, Holbrook says he's been asked whether sneezing with your eyes open will cause them to pop out of your head (he reassures his patients that he has never heard of this happening).

Another myth is that your heart temporarily stops while sneezing.

And then there's the photic sneeze reflex, which is one example that has a medical basis. Looking at bright light or going from dark to light (indoors to outdoors) triggers a sneeze in some people.

About 25 percent of the population has this reflex, and it appears to be hereditary.

Another response that might seem strange and also has a tendency to run in families is sneezing when you have a full stomach. O'Brien says that both her grandfather and father sneeze when they first take a few bites of chocolate, although neither man is allergic to it. Fortunately for O'Brien, she did not inherit this reaction.

The Dos and Don'ts of Sneezing

Sneezes are thought to travel at a speed of 100 miles an hour with a wet spray that may spread about five feet. So for those times when you need to say "achoo," there are some things to remember to do it safely.

Many experts agree that it was best to sneeze into the bend of your elbow, not into your hand. While you may have been taught as a child to cover your mouth with your hand when you sneeze to avoid spreading germs, kids and adults alike are now being taught to sneeze (or cough) into the inside of the elbow.

Sneezing into your hand is believed to be worse at spreading infection because the hand doesn't absorb mucus very well and often goes on to touch things afterward (instead of being immediately washed).

O'Brien also recommended keeping your mouth open because the sneeze is generating so much pressure you want to let it out.

As for what not to do, it could be risky to suppress a sneeze by pinching your nostrils or closing off your mouth. This can rupture an ear drum or damage the middle ear.

If you're going to sneeze, let it come, suggested Benninger. Historically, he explained, the Greeks believed that sneezing was a gift from the gods -- a signal from above, so to speak. This might be one reason why the phrase "Bless you" came into being, which probably was a derivative of "You are blessed."

As Benninger put it, "If people sneeze, just let them know they're blessed. The gods are with them."


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