There are times when stifling a sneeze my seem appropriate, like when you’re in a crowded elevator or meeting the queen. But a recent case study suggests you should probably just let it rip, wherever you are (just please, still cover your mouth).

As Jen Christensen at CNN reports, a 34-year-old man in Britain went to the emergency room after a painful experience while attempting to contain his sneeze. When he felt it coming on, he had pinched his nose closed and squeezed his mouth shut. But when the inevitable blast came, he experienced a popping sensation in his neck. A couple of hours later he began experiencing some pain, swelling and a voice change. An examination showed that he had air trapped around his trachea. In essence, he’d ripped a hole in his soft tissue of his throat and air was leaking into his neck. The incident was detailed in the British Medical Journal Case Reports.

“This 34-year-old chap said he was always trying to hold his sneeze because he thinks it is very unhygienic to sneeze into the atmosphere or into someone’s face. That means he's been holding his sneezes for the last 30 years or so,” report author and ear, nose and throat specialist Wanding Yang of the University Hospitals of Leicester NHS Trust tells Christensen. “But this time it was different.”

The patient was admitted to the hospital and administered antibiotics for seven days while being fed through a tube to allow the tear to heal.

The injury was unusual, more akin to what might happen to someone in a car accident or from a gun shot, Christensen reports. But it’s not the only time someone has injured themselves while holding in a sneeze. As Markham Heid at Time reports, people have fractured their larynxes, injured their neck vertebrae and screwed up their facial nerves by stifling a sneeze. “I’ve seen patients with a ruptured eardrum or pulled back muscles, and you hear about cracked ribs,” otolaryngologist Michael Benninger, chairman of the Head and Neck Institute at Cleveland Clinic, tells Heid.

There are other potential complications from holding in a sneeze, according to Rachel Szekely, a doctor also at the Cleveland Clinic. “By stifling a sneeze, you could push infected mucus through the eustachian tube and back into the middle ear,” she says. “You can get middle ear infections because of that.”

So why did we evolve sneezes so powerful they can rip throats, crack ribs and squirt mucus into our ears? Most researchers believe that sneezing helps clear irritants and things like viruses out of our systems by propelling them at around 100 miles-per-hour out of our noses and mouths. But Benninger tells Heid that’s probably not the full story. Sneezing might be a social cue to others that you’re sick and to stay away. Past research also suggests that the blast of air created by sneezing signals the cilia in our noses to kick into overdrive and clear out mucus and irritants.

Whatever the cause, the study authors suggest it's best to let your sneezes out. Just try to do it politely. High-speed video analysis of sneezes shows that an uninhibited sneeze creates a cloud of droplets that is much larger and travels more widely than researchers previously believed, and is capable of spreading pathogens even in the tiniest drop of sneeze mist.

So although you should sneeze with abandon, make sure to honk into a tissue or—if one is not available—into the crook of your elbow. Please don't sneeze into you're hand. That's also a great way to spread your cold.