When you feel a sneeze coming on, it’s best to let it out. Otherwise you could end up tearing a hole in your throat. That’s the advice being issued by doctors after a man in his 30s experienced a spontaneous tracheal perforation – a potentially deadly condition – as he tried to stifle a sneeze while driving. Battling to contain a sneeze by pinching his nose and shutting his mouth at the same time, the man suddenly felt shooting neck pain. Alarmed, he headed for the emergency unit in Dundee. Doctors at Ninewells hospital were stunned to hear a cracking sound after touching his neck and found he did not have control of movement. CT scans revealed the man had torn his windpipe. The case was reported in the medical journal BMJ Case Reports. Dr Rasads Misirovs, the report’s lead author, told the Guardian on Thursday that he and his colleagues had initially been puzzled by the cause of the man’s condition. “The patient presenting to hospital with a suddenly swollen neck following sneezes was quite surprising to us,” he said. “None of us had come across such presentation before other than holes in windpipes after injuries or complications of operations.” Key to unlocking the mystery of what had happened was confirming the precise sequence of the events, Misirovs said, followed by extensive scans of the patient. “X-ray of the soft tissues of the neck showed air in parts of the neck structures where there should be no air. We did computed tomography of the neck and chest which showed the extent of trapped air in neck and chest tissues and the location of the hole in the windpipe.” Misirovs said the case was unique. “The chances in running into complications like this one are extremely rare, nearly never. It’s like winning a million-pound lottery – a rare but potentially life-changing complication.” In this instance, the man had a lucky escape. He was given pain medication, admitted to hospital and kept under close observation for 48 hours. Within five weeks, the hole in his throat had healed. It could have been a lot worse, said Misirovs. If the mouth and nose are both closed during a sneeze, pressure in your upper airways can increase by up to 20 times. “The worst case scenario could be a burst trachea resulting in suffocation,” he said, or even a bleed in the brain. So what should people take from this episode? “My advice is to let the sneezes out as it is the body’s natural defensive mechanism to expel irritants from nasal passages,” Misirovs said. “We should gently cover the face either with our hand or inner side of elbow to prevent the irritants such as viruses, together with saliva and mucus, reaching others around us.”