According to Rae,1 tenderness is one of the most important and most constant signs of disease of the mastoid. There are instances, however, in which tenderness is absent, despite extensive disease in the mastoid bone. There are many factors which may influence or modify this tenderness, and they may be divided into (1) general and (2) local factors.
A. Is the Patient Hyposensitive or Hypersensitive?—According to Libman,2 patients are not all equally sensitive to pain and the same disease may cause varying clinical pictures in different persons. On the basis of reaction to pain, Libman divided patients into two groups: (1) hyposensitive and (2) hypersensitive. It is fundamentally important that otologists train themselves to differentiate between these clinical groups. This differentiation can be made fairly accurately by a study of the past history, by speaking at length with the patient and by the use of such methods as
ROSENWASSER H. CLINICAL EVALUATION OF TENDERNESS OF THE MASTOID. Arch Otolaryngol. 1943;38(5):447–452. doi:10.1001/archotol.1943.00670040466005
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