Why You Should Not Suppress Sneezing: Effect, Treatment

Article by Dr Raghuram Y.S MD (Ay) & Dr Manasa B.A.M.S
Sneeze might just be a response to some allergy and short living or embarrassing when it occurs in continuous bouts or troublesome when it is a part of some chronic respiratory disorder or when sneeze becomes chronic. 

Continuous sneezing is a symptom of some systemic disease or a local nasal disease or respiratory disease. Similarly ‘not sneezing at all’ is also abnormal.

Sneezing is a natural cleansing mechanism of respiratory tract.
Nose has a filter bed and it filters of almost undesired allergens or foreign bodies entering the nasal cavity. These things are thrown out of the system through sneeze reflex. Thus unwanted dust particles and pathogens are thrown out through sneeze.

Kshavathu

Kshavathu or sneeze is a natural reflex coming out as a response to various stimulating and irritating stimuli.These stimuli are often called as allergens. They are  pollens, spider web, dust, smoke, mist etc. They either initiate or trigger a sneeze reflex which can be a mild symptom or an annoying disease.

Sneeze can be due to low immunity – Chronic and uncontrollable sneeze stubborn to any medication can be a product of low immunity or may be the earliest symptoms of any disease or syndrome related to low immunity.

Concept of Sneeze as said in Ayurveda –
According to Charaka –
‘The vitiated Vata Dosha traversing all through the channels of the head touches the Marmas (delicate points) in the nose. When these Marmas of the nose get irritated, Kshavathu is produced’.

According to Sushruta –
‘When vitiated Vata in the head rushes into the nose along with kapha and disturbs the already afflicted Marmas, it produces discharges from the nose along with sounds.’

Shavathu – Adharaneeya Vega

Kshavathu, an Adhaaraneeya Vega
Ayurveda explains sneezing as one among the 13 natural urges that should not be suppressed. If these vegas are held back, they may produce a serious damaging impact on the body in the long run. Kshavathu or sneeze reflex is one among the adhaaraneeya vegas. (Adhaaraneeya = Not to be controlled, Vega = Reflex, Urge).
Related Reading – Adhaaraneeya Vega – Urges that should not be suppressed

Kshavathu Vega Dharana Lakshana

Symptoms of suppressing sneezing: Kshavathu Vega Dharana
Below mentioned are the symptoms of forcibly withholding the natural impending sneeze reflex or urge:

मन्यास्तम्भः शिरः शूलम् अर्दित अर्धावभेदकौ।
इन्द्रियाणां च दौर्बल्यं क्षवथोः स्याद् विधारणात्॥(च.सू.७/१६)
भवन्ति गाढं क्षवथोः विघाताद् शिरो अक्षि नासा श्रवणेषु रोगाः॥(सु.उ.५५)

Manyastambha – Pain in the nape of the neck (stiffness or rigidity of the neck, cervical or neck pain, cervical spondylosis)
Shira Shoola – Headache, Sinusitis
Ardita – Facial paralysis
Ardhavabhedaka – Hemicrania, Migraine, Half sided headache
Indriyaanaam Daurbalyam – Weakness (disorientation) of sense organs (structural or functional disability of sense organs)
Shiro Rogaaha – Diseases of the head
Akshi Rogaaha – Diseases of the eye
Nasa Rogaaha – Diseases of the nose
Karna Rogaaha – Diseases of the ear

Treatment

Treatment for disorders manifesting due to Kshavathu Vega Dhaarana –
Below mentioned are the treatment strategies which should be infollowed to combat the disorders manifesting due to forcible withholding of Kshavathu Vega or Sneeze reflex –

• Abhyanga – Local Massage with herbal oils
• Sweda – Local Fomentation (steaming, sweating treatment)
• Dhooma / Teekshna Dhooma – Fumigation with herbal medicaments / Fumes of strong and intense acting herbs
• Naavana – Nasal drops, Nasal irrigation (with herbal liquids)
• Vataghna Chikitsa and Aushadha – Vata mitigating treatments and medicines
• Auttara Bhaktikam Ghrutam – Medicated ghee should be given for consumption after food
• Anjana – Collyrium
• Arka Vilokana – Seeing the Sun

Modern perspective

What does modern science tell about the forcible withholding of sneeze reflex and its effects on health?
Holding of sneeze (stifled sneeze) may cause one or more of the below mentioned symptoms –

• Acute cervical (neck, nape) pain
• Facial nerve injuries
• Fractured larynx
• Eardrum rupture
• Pull of muscles
• Rib cracking
• Sinus infection
• Rupture of blood vessels
• Headache or stroke
• Diaphragm injury
• Eye Bulging

What Experts Say?
‘Sneezes are like laughter. Some laughs are loud, some are soft. And it’s similar with sneezing. It will often be the same from youth onward in terms of what it sounds like’ – Dr Alan Hirsch, Neurologist, Psychiatrist and founder of the Smell & Taste Treatment and Research Foundation. 

Some people may be recruiting more muscles into the violent sneeze response. Therefore you need not be embarrassed next time you blow away someone with the air coming out of your lungs through your nose’ – Jayakar Nayak, Assistant Professor of Otolaryngology at the Stanford Sinus Center

‘The suppression of a sneeze causes a massive build-up of pressure in our head, which can cause injuries such as a burst eardrum, tearing blood vessels and muscles in the head, damaging sinuses and even, in rare cases, brain hemorrhages’ – Professor Adam Carey, a sports injury specialist

‘Your nose connects to your Eustachian tube, which connects to your middle-ear and so you could also push things through the Eustachian tube and back into the middle ear (such as) mucus that is infected and you can get middle ear infections because of that’ – Dr Rachel Szekely, Cleveland Allergy Clinic

‘I have seen patients with a ruptured eardrum or pulled back muscles, and you hear about cracked ribs’ – Dr Michael Benninger, otolaryngologist, Head and Neck Institute at Cleveland Clinic
Findings of Dr Michael Benninger

Stifling sneeze caused this man to rupture his throat:
A person blocked his nostrils and mouth Man plugged both nostrils and mouth to block himself from sneezing. Doctors say the injury is very rare, but warn against blocking both nostrils to stifle a sneeze Suppressing sneezes can also injure eyes, chest, ears. Read more

According to Dr Michael Benninger, an otolaryngologist (ear, nose and throat doctor), chairman of the Head and Neck Institute at Cleveland Clinic –

The complaints in those forcibly holding sneeze reflex –

• Ruptured eardrum
• Pulled back muscles
• Cracked ribs

Benniger says – ‘While sneezes (and the schnozes that expel them) come in many sizes, a whopper sneeze can blast air out of your nose at 500 miles per hour. If you redirect that force inward, your suppressed sneeze can send waves of force rippling through your head and body’

Conditions which could lead to an adverse reaction to a held-in sneeze –

• A pre-existing musculo-skeletal injury or weakness
• Odd ear physiology
• Odd throat physiology
• Some other anatomical quirk

He further tells that Sneezes aren’t meant to be caged. Sneezing probably cleanses the nose of irritants, viruses and those types of things. It may also signal to people that you are sick. It may also reset the homeostatic environment in your nose.

It is wise enough not to hold in a sneeze. If one feels like stopping it due to some reason, he should rub the nose. Patients who may feel pain when sneezing, those who have recently undergone surgery or broken a bone, should open their mouth wide to minimize a sneeze’s strength. If the air can escape through your nose and mouth, that creates less pressure than forcing it through a smaller opening.

Case study

A case study from British Medical Journal : 
This case reports a rare spontaneous perforation of the pyriform sinus of pharynx after a forceful sneeze, leading to cervical subcutaneous emphysema and pneumomediastinum. Read more

Opinion of Alan Wild –
Alan Wild, Head and Neck surgeon and assistant professor of otolaryngology at Saint Louis University School of Medicine tells – ‘I wouldn’t recommend suppressing a sneeze by any method, whether by pinching one’s nose or consciously sneezing into a closed throat. Rubbing the nose, breathing forcefully the nose, and pressing on the upper lip below the nose may relieve the urge to sneeze, but once the sneeze starts, it is usually best to just let it go’

Holding in a sneeze or a blocked sneeze could cause –

• Injury to the diaphragm
• Break of blood vessels in the sclera / conjunctiva (white of the eye), causing bruising of the white part around the iris
• Force air up the Eustachian tubes in your ears and cause a ruptured ear drum or an injury to the inner ear that could lead to vertigo or hearing loss
• Weaken a blood vessel in the brain and cause it to rupture due to the momentary elevation of blood pressure

Aggressive sneezes can cause –

• Air to be pushed into the space around the eye in those who had sinus surgery causing bulging of the eye
• Air to be pushed into the brain cavity causing an intense headache or even stroke
• Neck injury from sudden extension of the neck
• Momentary incontinence

Important points
In 2009, a series of massive sneezes triggered a brain haemorrhage and heart attack that killed a man in Devon, England. He was heard and seen by staff at his care home sneezing violently two days before he died.

Research – ‘Laryngeal trauma (voice box injury) mechanisms can be classified as blunt or penetrating and as external or internal. Internal trauma is often iatrogenic, typically following intubation, or may be rarely caused by sneezing with a closed mouth, so called ‘Closed airway sneeze’
Interesting facts: Sneezology – world’s sneezing habits

Just Before Finishing –
Sneezing cleanses the system and keeps the respiratory passages healthy and sterile by identifying the foreign bodies entering the nasal passages and filtering them off. Sneeze pushes off the undesired things entering our breathing territory. It is also used as a sign of determining ‘Lucky and unlucky’ happenings. If someone sneezes while we set on to do some work, it is said to be a bad sign. On the other hand we try to hold on to the impending sneeze, like any other reflex (urge, vega) as we are embarrassed to let it happen while in groups or social gatherings. On a long term it may produce untoward health effects. When Sneeze occurs, just sneeze off!! This will keep you healthy.
Click to Consult Dr Raghuram Y.S. MD (Ayu)