title: Mastoid hyperpneumatization with atlantoaxial fistulization presenting as head rotation-induced aural fullness.
abstract: OBJECTIVE
  To describe a unique presentation of mastoid hyperpneumatization with atlantoaxial air fistulization.
  
  
  METHODS
  Case report, 30-year-old male patient.
  
  
  METHODS
  Descriptive case report.
  
  
  METHODS
  Subjective aural fullness, with objective tympanogram changes, induced by head rotation.
  
  
  RESULTS
  The patient complained of left ear fullness exclusively and repeatedly during neck extension and head rotation to the right side. These head positional changes cause a change of pressure of the atlantoaxial intra-articular emphysematous air, and these fluctuations in pressure are transmitted through the communicating mastoid fistula to the middle ear and tympanic membrane, leading to the sensation of ear fullness.
  
  
  CONCLUSIONS
  We hereby describe the first case of mastoid hyperpneumatization fistulizing into the atlantoaxial joint and presenting with an ipsilateral aural fullness that occurs mainly during contralateral head rotation and extension. This is a characteristic clinical sign that has not been previously described.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Nord University Hospital, Marseille, France. charbelrameh@hotmail.com
authors.forename: Charbel
authors.initials: C
authors.lastname: Rameh
authors.forename: Renaud
authors.initials: R
authors.lastname: Meller
authors.forename: Jacques
authors.initials: J
authors.lastname: Magnan
mesh_terms: D000158:Acoustic Impedance Tests; D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D004432:Ear, Middle / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004646:Emphysema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D005402:Fistula / Q000000981:diagnostic imaging / Q000473:pathology*; D019416:Head Movements; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging / Q000473:pathology*; D011312:Pressure; D011859:Radiography; D015898:Tomography Scanners, X-Ray Computed