title: An otalgia pain syndrome, the anterolateral tip of the mastoid syndrome (ATOMS): diagnosis and response to treatment.
abstract: BACKGROUND
  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.
  
  
  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.
authors.affiliation: Department of Otolaryngology, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Hagr
authors.forename: Manohar
authors.initials: M
authors.lastname: Bance
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use; D004433:Earache / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008416:Mastoid; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D013577:Syndrome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine