When it comes to sneezing, something’s gotta give — as one man learned after his attempt to hold in a sneeze led to a ruptured throat. This “previously fit and well” man pinched his nose and clamped up his mouth to stop the sneeze, but the buildup of force blew out his throat instead, sending him to the emergency room.

To be clear, this scenario is extremely rare. But, as described in a paper published today in BMJ Case Reports, it sounds terrifying. After trying the pinch-and-close maneuver, the 34-year-old man heard (and felt) a popping sensation in his neck. His neck swelled up. Unable to speak or swallow, he wisely went to the ER where, in addition to explaining the sneeze, he had to deny “having eaten anything sharp.”

It turns out that the sneeze was so forceful that it ruptured his pharynx — the membrane-filled cavity right behind the mouth — and led to the development of air bubbles in his neck. (This, called crepitus, is what caused those crackling sounds.) The ER doctors put him on a feeding tube and gave him antibiotics. He was discharged a week later and was fine at his two-month checkup.

For most people, holding back a sneeze is unlikely to lead to this result. As the authors of the case report note, this type of rupture is far more likely to happen because of an infection or other trauma. But they still argue that pinching your nose to hold back a sneeze — and holding back a sneeze more generally — should be avoided. Other doctors have seen held-back sneezes causing ruptured eardrums and pulled back muscles, so it’s perhaps better to err on the side of caution.

So what to do instead? “We recommend that if you feel like you have to sneeze DON’T plug the nose and instead open the mouth and try to get the sneeze to come out as a cough,” otolaryngologist Dale Tylor told Digg. In the end, it’s better to have an awkward sneeze than an ER visit.