Sneezing - Symptoms, Signs, Causes

Sternutation - Sneezing - Convulsive expulsion of air from the lungs through the nose and mouth


What are the causes of sneezing?

Sneezing is the unintentional spraying of air from the lungs towards the nose and mouth, usually caused by foreign particles that irritate or irritate the nasal mucosa. Sneezing, exposure to bright light, sudden temperature change, contact with allergen substances or the onset of viral infections can be seen. Sneezing attacks can be seen in upper respiratory tract infections and allergic rhinitis. During deep sleep, sneezing is not seen because sneezing reflex nerve pathways are not stimulated. Likewise, bright light facilitates sneezing with a different mechanism. Some individuals may experience sneezing attacks after binge eating or during sexual arousal.

How do we sneeze?

While foreign particles, allergens and other external stimuli pass through the nose, they touch the hairs in the nose before reaching the nasal mucosa. This situation, which causes histamine release, causes the nerves in the nose to be stimulated. A signal is sent to the brain through the stimulated nerves. Sneezing is initiated from the brain through the Trigeminal nerve network. The muscles surrounding the pharynx and windpipe work with the signals coming from the brain, and maximum opening occurs in the nose and oral cavity. The muscles of the face, neck and chest cavity also participate in the sneezing reflex. During sneezing, the eyelid also closes. During sneezing, while the soft palate and small tongue descend; tongue root points upward. In this way, while the air passage in the mouth region is closed; the nasal passage remains open and compressed air from the lungs exits through the nose. Allergens, particles and foreign substances taken through the nose are removed. If the mouth is opened during sneezing, the air pressure coming out of the nose decreases as the palate descent and tongue base cannot be fully made.

Is it dangerous to sneeze for a long time in a row?

Sneezing allows harmful particles and microbes in the nose to be expelled with compressed air. Sneezing in healthy people has no health risks. Especially in people with allergic rhinitis, successive sneezing attacks can be seen.

During sneezing, infectious particles ranging in size from 0.5 to 5 ┬Ám are scattered very quickly. In this way, upper respiratory tract infections can be transmitted to people outside. Closure of the mouth and nose area during sneezing can cause problems by causing sudden blood pressure changes, especially in individuals who have undergone vascular surgery, neurosurgery and similar surgeries, where blood pressure is risky. Apart from this, it has been reported that waist and neck hernia may occur due to sneezing.

During sneezing, the brain and heart vessels expand, the dead air space (residual volume) in the lungs is ejected. The resting period after the relaxation phase of the heart (diastole) may take a few milliseconds. In this rotation, it is as if the heart has acquired a very short shape. The origin of the custom of saying 'bless you' to people after sneezing is based on the Christians' phrase 'God bless you' or 'May God bless you'. This phrase, which was spoken in the sixth century as a congratulation to those who sneezed for throwing the devil in their bodies, was obliged to be said by the Pope when the great plague epidemic began and was enacted.

In people with sneezing attacks, avoiding dusty detergent, odorous, industrial wastes with allergens, avoiding sudden heat and light changes, washing the nose with saline water and allergy treatment may be beneficial to reduce sneezing attacks. When the sneezing attack begins, the nose wings can be gently squeezed and massaged, but if the attack has started despite this, the nose wing should be released.

Is it true that the heart stops when sneezing?

During sneezing, a serious increase in pressure occurs in the abdomen and then in the brain region. Due to this pressure, dilation occurs in the heart and brain vessels during sneezing. As if the heart is standing still for a very short time, the resting period after the relaxation phase of the heart is prolonged. This is true for the normal sneezing reflex and is beneficial for health. Holding the breath during sneezing can cause this pressure to increase much more and cause serious health problems.

Apart from these, in the normal sneezing reflex, the root of the tongue rises and the soft palate area is lowered, so that the air from the lung is directed towards the nose in a pressurized manner. During sneezing, tears, sinuses and nasal canals are opened. Foreign particles entering the body through the nose are scattered back to the environment at high speed.

What can we do to sneeze?

Sometimes sneezing may not be completed even if the sneezing reflex begins. For example, the sneezing reflex can be stimulated when going out from the dark to the light environment or from the cold to the warm environment. In this case, sneezing effort is not required. However, when the sneezing attack starts, looking at the light or going to a warm and bright environment can complete the sneezing attack. The tendency to sneeze is also thought to be a genetic trait. It is argued that some people have a more difficult sneezing reflex. This situation is not a disease.

How can we prevent sneezing when it comes?

Normally, sneezing is a defense system of our body against particles, microbes and allergens in the external environment. Correct sneezing is beneficial for the cardiovascular system and is important for cleaning the nasal-sinus tracts. There is no scientific method defined for stopping sneezes when they arrive. At the beginning of the sneezing reflex, the middle part of the nose and the tip of the patient may be squeezed. If sneezing started despite this, it is the opening of your nose. There are various controversial recommendations such as distributing the concentration.

Why do we sneeze when we look at the sun or light?

Exposure to light can increase the sneezing reflex by different mechanisms. The neural conduction responsible for sneezing is accelerated when exposed to light. However, our nose contains erectile tissues such as genital organs. When moving from a dark environment to an environment with sunlight, this may result in a sneezing reflex due to sun allergy or sneezing attacks triggered by the good mood, happiness and pleasure created by the light.
Exposure to bright light facilitates the neural stimulation of sneezing reflex in the brain. The onset of sneezing attacks with exposure to bright light in 18-35% of individuals in the society is a predisposition inherited by autosomal dominant inheritance.

Is there any harm in sneezing?

During sneezing, blood pressure in the abdomen and head area increases. During sneezing, in the presence of an infectious disease or allergic inflammation involving the nasal mucosa, the nasal vessels are more sensitive to blood pressure changes. In this case, nose bleeding may begin during sneezing. In such a case, it is recommended to wash the inside of the nose with cold water. Pads and similar materials placed after nasal surgery can also initiate a sneezing attack with irritation and initiate nasal bleeding with increased pressure. Apart from this, trying to close the mouth and nose area completely during sneezing causes these pressure changes to be much more; It may initiate bleeding attacks, especially in people who have had an intracranial surgery or aneurysms, patients who have undergone intra-abdominal surgery, and patients who have undergone cardiovascular surgery. It has also been reported that waist and neck hernias can be seen during severe sneezing attacks. Opening the mouth during sneezing reduces this pressure increase.

Is it harmful to hold sneezes?

Closing the mouth and nasal airways during sneezing can normally increase the intracranial and intraabdominal pressure increases too much, and in this case, negative effects may occur in different tissues and ratios. In patients with intracranial aneurysm or vascular anomalies, patients with previous cerebral hemorrhage, patients with bleeding disorders, patients using blood thinners, patients who have undergone surgery related to intracranial and cardiovascular system, closing the mouth and nose during sneezing can initiate a bleeding attack. . The sneezing of these patients with their mouth open allows the air from the lungs to exit from the mouth with less pressure. Sneezing is a useful reflex developed against harmful particles in the outdoor air.

Why does dust or pollen cause sneezing?

Air entering in the nose rotates and moves backward. In particular, it is ensured that the air in the nose is moistened, purified, heated and sent to the lungs under pressure by hitting the nasal meat. When dust or allergen substances are found in the nasal air, histamine is secreted by the immune system's defense cells in the mucosa lining the nose, causing symptoms such as runny nose, sneezing and watery eyes. Typically, sneezing attacks increase in environments where allergens are present, and sneezing attacks decrease when this environment is removed. As the frequency of contact increases, the frequency of attacks may increase with sneezing attacks. Sneezing attacks can play a protective role in preventing these dust and allergens from getting into the lungs.

How to stop allergic sneezing?

Avoiding allergen contact is the first precaution in sneezing attacks due to allergic rhinitis. For dusty workers, it may be beneficial to use a mask and wash the nose with salty water. Apart from that, treatments can be given according to sneezing and accompanying symptoms. These include antihistamine drugs, leukotriene receptor antagonists, nasal steroids, and rarely systemic cortisone therapy. Allergic rhinitis is seen in two different forms, seasonal and perennial. There is no known curative treatment for allergic rhinitis. Allergen-specific therapy or immunotherapy is also used in the treatment of allergic rhinitis.

Can sneezing cause brain hemorrhage?

In people who have had a cerebral hemorrhage, who have a bleeding disorder, who use blood thinners, have vasculitis or aneurysms that tend to bleed in the head, cerebral hemorrhage due to sneezing can be seen very rarely. During a sneezing attack, tight closure of the mouth and nose area can exaggerate the intra-abdominal and intracranial pressure and this may increase the possibility of bleeding. During sneezing, opening the mouth can reduce the pressure that may occur by directing the air from the lungs into the mouth instead of the narrow nasal canal. It is a useful reflex for sneezing, cleaning the nasal and sinus tracts.

Can sneezing cause miscarriage?

In a normal pregnancy process, sneezing does not harm the baby. It is argued that frequent sneezing may increase the risk of miscarriage in patients with cervical deformation or more than normal opening. Apart from this, pregnant patients do not need to take any special precautions during sneezing, but tight closure of the mouth and nose area of ​​pregnant women close to the time of delivery may cause problems by increasing the intra-abdominal pressure to very high levels.

If there is too much alcohol in the expiratory air, sneezing on a cigarette can create a bomb effect!

I came across this video by chance under the title "atomic sneeze" on the internet. A man with a cigarette in his hand sneezes and there is a fire rising from his face towards the ground. It must be a breath containing a very high alcohol content ­čśë

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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