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An otalgia pain syndrome, the anterolateral tip of the mastoid syndrome (ATOMS): diagnosis and response to treatment.

INTRODUCTION
Otalgia is a common presenting disorder. We describe a pain entity characterized by localized pain at the anterolateral tip of the mastoid (ATOM), which can be diagnosed by location and response to lidocaine (Xylocaine) injection. Long-term therapeutic results are described following a single injection of lidocaine. We compared 11 patients with this pain location to 24 patients with nonspecific otalgia.


MATERIALS AND METHODS
In a tertiary otology centre, patients with severe ATOM-related pain were treated using 3 cc of 1% lidocaine injection; pain scores were measured before and afterward with a questionnaire, which also probed the effects on general lifestyle or possible causative factors. A consecutive group of 64 patients referred to the clinic, who also filled out the questionnaire, were used as a reference group.


RESULTS
The average severity of the pain was 7.6 of 10 prior to injection, and at 1 hour, this fell to 1.5, at 1 day to 2, at 1 week to 0.6, and to 1.9 at the 10-month follow-up. The duration of the pain, if intermittent, also fell significantly. Of the 11 patients, 9 had previous ear surgery. There was a higher incidence of females, tooth grinding, and ear surgery in the ATOM group than in the non-ATOM otalgia group.


CONCLUSIONS
ATOM pain is another cause of otalgia symptoms that should be recognized and often responds to local anesthetic injection.