Abstract
Idiopathic causes of retroauricular pain are rarely seen in clinical practice. We present a 9-year-old child who suffered from atypical retroauricular pain resistant to conventional treatment. After excluding any other cause of retroauricular pain, a nerve block was performed with a 0.3 ml lidocaine 1% injection into the trigger point. We believe that this case report is important because in the literature there are no similar cases described in children.
1
Introduction
Retroauricular pain is a common symptom that can be indicative of different diseases. The most common causes are otomastoiditis, Herpes Zoster oticus, tension type headache, migraine, trigeminal (tic douloureux) and occipital neuralgias, temporal or neck trauma, inflammation of fibrous tendinous structures, ear or neck surgery and temporal mandibular joint dysfunction .
The innervation of the retroauricular region consists of various nerves including the great occipital, the great auricular, the lesser occipital and the auriculotemporal nerves. Therefore, it can be difficult to identify the nerve responsible for the pain .
We present the case of a 9-year-old child who suffered from atypical retroauricular pain cured by the injection of lidocaine. We believe that this case report is important because in the literature there are no similar cases described.
2
Case report
A 9-year-old child was admitted to our hospital because of a left retroauricular pain that started two months before. The pain could be described as stabbing, paroxysmal and burning. It was worsened by compression at the symptomatic area in the upper middle part of the retroauricular region. There was no proven pathophysiologic mechanism for this pain. The child did not describe other associated symptoms and signs (nausea, vomiting, fever, facial weakness, local edema, rash or vesicles) and he had no history of headaches neither traumatic injuries nor surgery involving the head and neck. His pain did not respond to various analgesics and non-steroidal anti-inflammatories. At the initial evaluation the patient was neurologically and otologically normal. Audiological testing was normal. The patient underwent cervical and brain MR imaging and temporal bone CT to exclude other causes for ear pain. Laboratory examinations were also normal. Neuropsychiatric evaluation was negative. Orthopedic evaluation excluded muscle pain. Epiaortic ultrasound was negative too.
At the entrance the pain was treated with corticosteroids without any improvement. After this first treatment the patient began a therapy with carbamazepine 400 mg, but once again after three weeks from the beginning of therapy there was no pain resolution. Then carbamazepine was changed to gabapentin 300 mg for 2 weeks and 600 mg for other 2 weeks without any results. A nerve block was performed even if it was not possible to identify the nerve responsible for the pain . After mild sedation and aseptic preparation 0.3 ml lidocaine 1% was injected into the trigger point ( Fig. 1 ) . The pain started to reduce after a few hours and after 48 hours the patient was symptom free.
A follow up 1 and 3 months after the lidocaine injection confirmed complete recovery from symptoms.
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