Reverse Sneezing in Shih Tzu: Causes, Symptoms, and What to Do

By Janice Jones    |Published 02-13-20     |Last updated 10-23-2026

Have you ever heard your Shih Tzu suddenly make a loud snorting, honking, or gasping sound, almost as though something is stuck in their throat? It can be frightening, especially if you've never heard it before.

Your dog may be experiencing something called reverse sneezing. Although it can sound alarming, most episodes are harmless and resolve quickly on their own.

But how can you tell whether your Shih Tzu is reverse sneezing or having trouble breathing? And is there anything you can do to help?

Let's look at what causes reverse sneezing, what it looks and sounds like, and when it's time to call your veterinarian.

What Is Reverse Sneezing?

Reverse sneezing, also called paroxysmal respiration, is a reflex that causes a dog to take several sudden, forceful breaths inward through the nose.

During a normal sneeze, air is expelled outward through the nose. During a reverse sneeze, the opposite happens: air is drawn rapidly inward.

According to Cornell University's College of Veterinary Medicine, reverse sneezing occurs when something irritates the nasopharynx, the area behind the nasal passages and above the roof of the mouth.

This irritation triggers a reflex that produces repeated, noisy inhalations.

Although the sounds can make it seem as though your dog is struggling to breathe, most episodes are brief, and dogs generally return to their normal activities afterward.

Reverse sneezing isn't a disease itself. It's a symptom or reflex that can happen for several reasons.

 What Does Reverse Sneezing Look and Sound Like?

If you've never witnessed an episode, you might mistake reverse sneezing for choking, coughing, or a more serious breathing problem.

During a typical episode, your Shih Tzu may:

• Stand still with their neck extended.
• Tilt their head slightly backward.
• Keep their mouth closed.
• Flare their nostrils.
• Make repeated snorting, honking, or gasping sounds.
• Hold their elbows slightly away from their body.

The sounds come from repeated inward breaths through the nose.

An episode may last only a few seconds, though some last a minute or longer. Cornell notes that episodes can sometimes last several minutes.

Most dogs recover quickly and return to normal behavior afterward.

A helpful suggestion: If your Shih Tzu experiences these episodes, consider recording a short video to show your veterinarian. The sounds and movements may help your vet determine whether your dog is reverse sneezing or experiencing another respiratory problem.

Why Are Shih Tzus Prone to Reverse Sneezing?

Reverse sneezing can occur in any dog, regardless of breed, age, or sex. However, Cornell reports that it occurs more often in smaller dogs and brachycephalic breeds.

Shih Tzus belong to this group.

Brachycephalic dogs have shortened skulls and relatively flat faces. Their upper airway anatomy differs from that of dogs with longer muzzles.

Some Shih Tzus also have narrowed nostrils, an elongated soft palate, or other anatomical features that can interfere with normal airflow.

These characteristics may contribute to upper airway irritation or breathing difficulties.

However, not every breathing noise in a Shih Tzu is reverse sneezing.

Some dogs experience brachycephalic obstructive airway syndrome (BOAS), which can cause persistent noisy breathing, exercise intolerance, and respiratory distress.

If your Shih Tzu regularly struggles to breathe, snores heavily while awake, or has difficulty tolerating exercise or warm weather, don't assume reverse sneezing is responsible.

A veterinary examination can help identify the underlying problem.

What Causes Reverse Sneezing in Dogs?

Reverse sneezing often begins when something irritates the upper respiratory tract.

Sometimes the trigger is obvious. Other times, you may never know exactly what caused the episode.

Common triggers

• Dust, pollen, and other irritants: (Dust, allergens, and other airborne particles may irritate the tissues behind your dog's nose.)
• Excitement:  (Some dogs experience episodes when they're excited, such as when greeting someone or anticipating a favorite activity.)
• Eating or drinking too quickly:  (Rapid eating or drinking may trigger reverse sneezing in some dogs.)
• Pulling against a leash:  (Pressure around the neck may trigger an episode, especially when a dog pulls hard against a collar.)
• Foreign material:  Grass, plant material, or other foreign objects can sometimes become lodged in the upper respiratory tract and cause irritation.

Other possible medical causes

Cornell also identifies several conditions that may contribute to reverse sneezing, including:

• Upper respiratory infections.
• Nasal mites.
• Masses or growths.
• Lower airway disease.
• Brachycephalic obstructive airway syndrome.
• Certain gastrointestinal problems, including vomiting.

Many dogs experience occasional reverse sneezing without an identifiable underlying cause.

Veterinarians sometimes describe these cases as idiopathic, meaning the cause is unknown.

What Should You Do When Your Shih Tzu Reverse Sneezes?

Watching your Shih Tzu struggle through a noisy episode can be unsettling. Fortunately, most reverse sneezing episodes resolve without medical treatment.

Here are some practical steps you can take.

1. Stay calm

Your dog may already be startled by the unusual sensation.

Speak softly and avoid adding to the excitement. If your Shih Tzu wants to stay still, let them.

2. Gently massage the throat

Cornell notes that gently massaging a dog's throat may help some episodes resolve more quickly.

Use a light touch, and don't restrain your dog or press on the windpipe.

If your Shih Tzu resists being touched, stop and allow them to settle.

3. Give your dog time to recover

Most episodes end spontaneously.

Once the reverse sneezing stops, watch your Shih Tzu for a few moments to make sure their breathing has returned to normal.

4. Reduce possible triggers

If you notice episodes after exposure to dust, strong fragrances, excitement, or pulling on a collar, try reducing those triggers.

For example, a properly fitted harness may be better than a collar that puts pressure on the neck.

What about covering the dog's nostrils?

Some veterinary references, including Cornell, mention briefly closing a dog's nostrils or gently blowing toward the face to encourage swallowing.

However, because Shih Tzus can have underlying airway restrictions, I don't recommend that owners routinely try these techniques without guidance from their veterinarian.

For most occasional episodes, staying calm and letting the episode pass is enough.

Important: Never attempt to restrict airflow if your dog appears to be genuinely struggling to breathe.

When Should You Call Your Veterinarian?

Occasional reverse sneezing in an otherwise healthy dog is usually not a cause for concern.

However, not every episode of unusual breathing is harmless.

Schedule a veterinary examination if your Shih Tzu:

• Begins reverse sneezing frequently or more severely than usual.
• Experiences episodes that last longer or are harder to recover from.
• Has persistent coughing, nasal discharge, or other respiratory symptoms.
• Seems unusually tired or uncomfortable afterward.
• Has noisy or labored breathing between episodes.
• Develops reverse sneezing suddenly after never having episodes before.

A veterinarian can examine your dog's nose, throat, and airways to determine whether another condition is contributing to the problem.

When breathing problems are an emergency

Seek emergency veterinary care if your Shih Tzu:

• Has blue, gray, or unusually pale gums.
• Collapses or loses consciousness.
• Has severe or persistent difficulty breathing.
• Appears unable to get enough air.
• Remains in significant respiratory distress after the episode should have ended.

Do not dismiss these symptoms as ordinary reverse sneezing.

Reverse Sneezing vs. Other Breathing Problems

Because Shih Tzus are a brachycephalic breed, it's especially important to distinguish reverse sneezing from other respiratory conditions.

These descriptions are general distinctions, not a way to diagnose your dog at home.

For more information about breathing difficulties associated with the breed, see our guide to Shih Tzu Breathing Problems.

Can Reverse Sneezing Be Prevented?

You may not be able to prevent every episode, particularly if your Shih Tzu is naturally prone to reverse sneezing.

However, reducing potential irritants and triggers may help.

Consider the following:

• Keep your dog's environment as free as possible of dust and airborne irritants.
• Avoid spraying strong fragrances or cleaning products near your dog.
• Use a properly fitted harness if your dog tends to pull against a collar.
• Encourage calmer eating and drinking if rapid consumption seems to trigger episodes.
• Watch for patterns, such as episodes occurring during certain seasons or activities.

These measures may reduce trigger exposure, but they aren't guaranteed to prevent reverse sneezing.

If episodes are frequent, your veterinarian may recommend further investigation or treatment of an underlying condition.

How Do Veterinarians Treat Reverse Sneezing?

Most dogs with occasional reverse sneezing don't require medication or other treatment.

If episodes are frequent, severe, or accompanied by other symptoms, your veterinarian may investigate possible causes.

According to Cornell, treatment may involve addressing allergies or nasal mites if suspected.

If symptoms persist, diagnostic procedures may include mouth and throat exams, imaging, or rhinoscopy, which lets the veterinarian examine the nasal passages with specialized equipment.

Dogs with significant airway abnormalities, such as an elongated soft palate that contributes to breathing difficulties, may benefit from surgery.

Treatment depends on the underlying diagnosis, not reverse sneezing alone.

My Experience With Reverse Sneezing in Shih Tzu

For what it's worth, I've lived with Shih Tzus for 50-plus years, and I've heard this sound numerous times over my lifetime.  Not all of my dogs have had problems with reverse sneezing, but the ones that have can be worrisome.  When Reverse sneezing was a problem, I found it was more common in windy, dusty environments, like when we lived in the Texas Panhandle. 

I also noticed that some dogs get very excited and run around wildly when they are young.  (Zoomies?)

I also had a couple of dogs that had extremely short noses.  People love that flat-face look, but those dogs are also prone to Brachycephalic Syndrome.  

In all cases, we identified the trigger or triggers, and as the dog aged, the reverse sneezing episodes became less frequent.

Frequently Asked Questions About Reverse Sneezing

Final Thoughts

Reverse sneezing is one of those canine behaviors that can sound much worse than it actually is.

For most Shih Tzu, an occasional episode is brief and ends without any lasting problems. Once you recognize the characteristic snorting sounds and extended-neck posture, you may find the experience less alarming.

Still, remember that Shih Tzu can have other respiratory problems that need medical attention.

If your dog's breathing changes, episodes become more frequent, or something simply doesn't seem right, it's always worth calling your veterinarian.

Understanding what's normal for your own Shih Tzu is one of the best ways to recognize when something needs attention.

Veterinary Reference

Cornell University College of Veterinary Medicine, Richard P. Riney Canine Health Center. Reverse Sneezing. Veterinary guidance featuring Brian Collins, DVM.

As an Aside

Is the plural of Shih Tzu Shih Tzus or Shih Tzu?  I was always under the impression that the singular and plural are the same, but I have seen both used.  The Collins English Dictionary, incorporating Webster's New World, recognizes both "Shih Tzu" and "Shih Tzus" as acceptable plurals.  But the American Kennel Club lists Shih Tzu as both singular and plural.

Janice Jones is a Shih Tzu specialist and former breeder with a background in veterinary care, grooming, training, and canine behavior. She has spent nearly 50 years working with the breed and ran a home-based breeding program for 15 years, raising well-socialized puppies. Early in her career, she worked as a veterinary assistant supporting surgery, x-rays, and lab work. She shares practical guidance at miracleshihtzu.com and across social platforms. Today, she enjoys the quiet companionship of her aging dogs, understanding them as they understand her.

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You guessed it, I'm not a trained dog walker.