Abstract
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. Longterm 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.