title: Hyperpneumatisation of the craniocervical bones: an emerging aetiological pattern.
abstract: BACKGROUND
  Hyperpneumatisation of the skull base and upper cervical vertebrae is a very rare condition of uncertain aetiology and pathophysiology.
  
  
  METHODS
  A case of extensive hyperpneumatisation of the craniocervical junction and upper three cervical vertebrae is described, in a patient who habitually performed the Valsalva manoeuvre to relieve the symptoms of a patulous eustachian tube. Reported symptoms of ear, neck and shoulder pain deteriorated after minor head trauma. There was a drastic radiological and clinical improvement after ceasing to perform the Valsalva manoeuvre.
  
  
  CONCLUSIONS
  All reported cases of craniocervical bone hyperpneumatisation have in common a history of raised middle-ear pressure, minor trauma or both. We therefore suggest that chronically raised middle-ear pressure leads to destruction of bony tissue and pneumatisation, and that this process is able to cross joints into the cervical spine, either via micro-fractures following trauma, or as a result of congenital assimilation of the craniocervical junction.
authors.affiliation: Department of Otolaryngology, University Hospital Coventry, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Fussey
authors.affiliation: Department of Neurosurgery, University Hospital Coventry, UK.
authors.forename: H
authors.initials: H
authors.lastname: El-Maghraby
authors.affiliation: Department of Otolaryngology, University Hospital Coventry, UK.
authors.forename: D
authors.initials: D
authors.lastname: Rejali
mesh_terms: D006801:Humans; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D014636:Valsalva Maneuver; D008297:Male; D005064:Eustachian Tube / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D000328:Adult; D019291:Skull Base / Q000000981:diagnostic imaging
keywords: Ear, Middle; Eustachian Tube; Skull Base; Valsalva Maneuver