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Spontaneous Pharynx Perforation After Forceful or Stifled Sneeze

TUESDAY, Jan. 16, 2018 -- Spontaneous pharyngeal perforation can occur after a forceful sneeze, according to a case report published online Jan. 15 in BMJ Case Reports.

Wanding Yang, from the University Hospitals of Leicester NHS Trust in the United Kingdom, and colleagues describe the case of a 34-year-old man who presented to the emergency department with an acute onset of odynophagia and change of voice following a forceful sneeze. The patient described a popping sensation in his neck and bilateral neck swelling after trying to stop a sneeze by pinching his nose and holding his mouth closed.

According to the authors, swelling and tenderness were noted on physical examination, especially on the right side of the cervical region. In both sides of the anterior neck, crepitus was noted, extending down to the sternum. Normal laryngeal appearance was seen on fiber-optic nasal pharyngoscopy, with bilateral functioning vocal cords. The patient had streaks of air in the retropharyngeal region and extensive surgical emphysema observed in lateral soft tissue neck radiograph. Extensive soft tissue emphysema was seen, which was predominantly centered within the neck and the pneumomediastinum. The air collections were thought to result from a pharyngeal tear. The patient was admitted and treated with enteral feeding and prophylactic antibiotics. Seven days later, the nasogastric tube was removed and a soft diet was introduced. The patient did not present any further recurrence or complications at two-month follow-up.

"In conclusion, spontaneous pharyngeal perforation can rarely occur after a forceful sneeze especially against a closed glottis," the authors write.

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Posted: January 2018