Hyperpneumatisation of the craniocervical bones: an emerging aetiological pattern
J M Fussey1, H El-Maghraby2, D Rejali1
1Department of Otolaryngology, University Hospital Coventry, UK.
Background:
Hyperpneumatisation of the skull base and upper cervical vertebrae is a very rare condition of uncertain aetiology and pathophysiology.
Case Report:
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.
Discussion:
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.
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