Did you know that when you sneeze, 100,000 germs fly out of your nasal canal at approximately 100 miles per hour? So, it’s easy to understand why many people try to muffle those annoying “ahhh-choos” in public. Whether you hold a sneeze by pinching your nose or closing your mouth, stifling a sneeze is not a good idea, according to UAMS audiologist Dr. Alison Catlett Woodall.

“Prior to a sneeze, a significant amount of air pressure builds in the lungs in preparation of being forced through the nasal cavity to clear irritants out of the nasal passages,” Dr. Woodall says. “If the sneeze is held in by pinching the nose or holding the mouth closed, this pressurized air is forced back through the Eustachian tube and into the middle ear cavity.”

The risk of a hearing loss injury due to holding a sneeze is low. However, it is not impossible. Woodall says the pressure behind a sneeze is capable of causing middle and inner ear damage, including a ruptured ear drum.

“This type of trauma to the membranous structures of the middle and inner ear has caused sudden severe sensorineural hearing loss, conductive hearing loss and even vertigo,” she says.

Other physical injuries that may result from holding a sneeze include diaphragm injuries, ruptured blood vessels in the eyes, and ruptured or weakened blood vessels in the brain.

How do you avoid these injuries? The best option is to just let those sneezes out!