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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de la oreja roja &#40;SOR&#41; es un s&#237;ndrome de origen neurovascular probablemente infradiagnosticado que supone un reto diagn&#243;stico y terap&#233;utico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Una mujer de 66 a&#241;os&#44; al&#233;rgica a la penicilina&#44; consult&#243; por unos episodios de 10 a&#241;os de evoluci&#243;n de dolor&#44; eritema y tumefacci&#243;n en el pabell&#243;n auricular izquierdo que se resolv&#237;an espont&#225;neamente en unas pocas horas o d&#237;as&#46; En los &#250;ltimos 6 meses&#44; el n&#250;mero de episodios se hicieron m&#225;s frecuentes hasta alcanzar los 5 brotes mensuales&#46; Entre sus antecedentes destacaba una intervenci&#243;n quir&#250;rgica por una fractura mandibular ipsolateral 40 a&#241;os antes&#46; La paciente no presentaba s&#237;ntomas sist&#233;micos&#44; negaba la aplicaci&#243;n t&#243;pica o la ingesta de f&#225;rmacos y no identificaba otros posibles desencadenantes&#46; En la exploraci&#243;n f&#237;sica se observ&#243; un eritema y tumefacci&#243;n del pabell&#243;n auricular izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a> A y B&#41;&#44; sin otros signos cut&#225;neos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Con estos hallazgos cl&#237;nicos&#44; y descartadas otras posibles causas&#44; la paciente fue diagnosticada de un SOR&#46; Se inici&#243; tratamiento conservador con medidas f&#237;sicas como la aplicaci&#243;n de fr&#237;o local y antiinflamatorios no esteroideos&#44; con una buena respuesta&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El SOR fue descrito por primera vez por Lance<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> en 1994&#46; Cl&#237;nicamente&#44; se caracteriza por unos episodios parox&#237;sticos de enrojecimiento y dolor o quemaz&#243;n del pabell&#243;n auricular&#44; que puede irradiar a la mejilla&#44; la mand&#237;bula o la zona occipital ipsolateral&#46; Hasta un 60&#37; de los casos presentan episodios unilaterales&#44; un 30&#37; bilaterales y un 10&#37; alternantes&#46; Los episodios suelen durar desde pocos minutos a horas&#44; con una frecuencia variable&#44; y pueden producirse espont&#225;neamente o despu&#233;s de un est&#237;mulo f&#237;sico como cepillarse&#44; lavarse los dientes&#44; masticar&#44; manipular la oreja o movilizar las cervicales<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La inervaci&#243;n sensitiva de la oreja es compleja&#46; La regi&#243;n anterosuperior del pabell&#243;n auricular y el trago est&#225;n inervados por el nervio auriculotemporal &#40;rama colateral de la divisi&#243;n mandibular del nervio trig&#233;mino&#41;&#46; El l&#243;bulo y la regi&#243;n posteroinferior est&#225;n inervados por el nervio auricular mayor &#40;rama del plexo cervical superficial formado por anastomosis de las ramas cervicales C2-C3&#41;&#46; La irrigaci&#243;n vascular deriva principalmente de las ramas de la arteria car&#243;tida externa &#40;arterias temporal media y auricular posterior&#41;&#44; que a su vez est&#225; inervada sensorialmente por el nervio trig&#233;mino<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a>&#46; El mecanismo de control vasomotor de la piel auricular deriva principalmente de variaciones del tono simp&#225;tico y&#44; en un segundo lugar&#44; del tono parasimp&#225;tico&#46; Es probable que el enrojecimiento observado en el SOR sea el resultado de una vasodilataci&#243;n excesiva secundaria a una desregulaci&#243;n producida por la activaci&#243;n de las fibras parasimp&#225;ticas y la inhibici&#243;n del tono simp&#225;tico<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El SOR se divide en s&#237;ndrome primario y secundario&#46; En 2013 Lambru et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> propusieron unos criterios cl&#237;nicos para el diagn&#243;stico del SOR primario &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El primario normalmente se describe en mujeres j&#243;venes con episodios migra&#241;osos&#44; durante los pr&#243;dromos o durante los ataques&#46; Entre los mecanismos etiopatog&#233;nicos subyacentes del SOR primario se ha propuesto una disfunci&#243;n de los nervios perif&#233;ricos cervicales o de los nervios centrales de las v&#237;as trig&#233;mino-auton&#243;micas&#46; Por otro lado&#44; el SOR secundario se describe con mayor frecuencia en mujeres de mayor edad sin antecedentes de migra&#241;a&#46; Pueden estar asociados a lesiones org&#225;nicas intracraneales o cervicales&#44; trastornos de la articulaci&#243;n temporomandibular&#44; s&#237;ndrome tal&#225;mico&#44; herpes z&#243;ster&#44; adenoma pleomorfo de cuerpo carot&#237;deo y toxicidad secundaria a f&#225;rmacos como la citarabina<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">En el diagn&#243;stico diferencial debemos incluir la policondritis recidivante&#44; la dermatitis de contacto&#44; el herpes z&#243;ster y la erisipela<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a>&#46; Tambi&#233;n debemos considerar la urticaria por presi&#243;n y el <span class="elsevierStyleItalic">flushing</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">El tratamiento se dirige a la causa subyacente y al alivio de los s&#237;ntomas&#46; En general&#44; los resultados terap&#233;uticos son poco satisfactorios&#46; Entre las medidas conservadoras se incluyen la terapia f&#237;sica&#44; aplicando fr&#237;o local o compresi&#243;n manual var&#237;as veces al d&#237;a&#44; los movimientos cef&#225;licos y el uso de f&#233;rulas dentales&#46; Entre los tratamientos t&#243;picos se incluyen los emolientes&#44; los corticoides y los inhibidores de la calcineurina&#46; Los tratamientos sist&#233;micos se suelen reservar para los casos muy sintom&#225;ticos o asociados a episodios de migra&#241;a&#46; Se han utilizado los antiinflamatorios no esteroideos&#44; los antidepresivos tric&#237;clicos&#44; los agonistas y antagonistas serotonin&#233;rgicos&#44; los betabloqueantes&#44; los bloqueadores del canal del calcio&#44; diferentes antiepil&#233;pticos y la ivermectina por v&#237;a oral&#46; Finalmente&#44; en los casos m&#225;s intensos&#44; se han descrito procedimientos invasivos mediante inyecciones de toxina botul&#237;nica o bloqueos nerviosos con anest&#233;sicos locales<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el SOR es una enfermedad rara y poco conocida por los dermat&#243;logos&#46; Es fundamental descartar otras entidades cl&#237;nicas&#44; as&#237; como causas subyacentes&#44; mediante una anamnesis dirigida que recoja los antecedentes m&#233;dico-quir&#250;rgicos y una exploraci&#243;n f&#237;sica exhaustiva&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">A&#46; Al menos 20 episodios que cumplan los criterios B-E</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">B&#46; Episodios de dolor del pabell&#243;n auricular de al menos 4 h de duraci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">C&#46; Dolor auricular con al menos 2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">de las siguientes caracter&#237;sticas&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Quemante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderado a intenso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desencadenado por est&#237;mulos cut&#225;neos o t&#233;rmicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">D&#46; Dolor auricular con eritema ipsolateral</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">E&#46; M&#225;s de un brote al d&#237;a&#44; aunque pueden existir casos con menor frecuencia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">F&#46; Descartar otras causas subyacentes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">B&#58; bilateral&#59; D&#58; dolor&#59; P&#58; prurito&#59; Q&#58; quemaz&#243;n&#59; U&#58; unilateral&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;ndrome de la oreja roja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Policondritis recidivante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dermatitis de contacto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Herpes z&#243;ster&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Erisipela&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Urticaria por presi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Flushing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ntomas&#58; D&#44; Q&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#44; Q&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Q&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#44; Q&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#44; Q&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n de los brotes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&#47;h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frecuencia de los brotes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brote &#250;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brote &#250;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Afectaci&#243;n auricular&#58;U o B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U &#62; B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#62; U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#62; U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#62; U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otros signos cut&#225;neos distintos del eritema y la tumefacci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Condritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descamaci&#243;n y ves&#237;culas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ves&#237;culas y costras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Supuraci&#243;n y puerta de entrada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cl&#237;nica sist&#233;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fiebre&#44; condritis nasal o de la v&#237;a a&#233;rea y poliartritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eczemas en otras localizaciones corporales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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CARTA CIENTÍFICO-CLÍNICA
El síndrome de la oreja roja: un gran desconocido
Red Ear: A Poorly Understood Syndrome
P. Garbayo-Salmons
Corresponding author
pgarbayo@gmail.com

Autor para correspondencia.
, V. Expósito-Serrano, M. Ribera Pibernat
Servicio de Dermatología, Hospital Universitario Parc Taulí de Sabadell, Sabadell, Barcelona, España
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Eritema y tumefacci&#243;n de la oreja izquierda &#40;B&#41;&#44; sin afectaci&#243;n de la oreja contralateral &#40;A&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de la oreja roja &#40;SOR&#41; es un s&#237;ndrome de origen neurovascular probablemente infradiagnosticado que supone un reto diagn&#243;stico y terap&#233;utico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Una mujer de 66 a&#241;os&#44; al&#233;rgica a la penicilina&#44; consult&#243; por unos episodios de 10 a&#241;os de evoluci&#243;n de dolor&#44; eritema y tumefacci&#243;n en el pabell&#243;n auricular izquierdo que se resolv&#237;an espont&#225;neamente en unas pocas horas o d&#237;as&#46; En los &#250;ltimos 6 meses&#44; el n&#250;mero de episodios se hicieron m&#225;s frecuentes hasta alcanzar los 5 brotes mensuales&#46; Entre sus antecedentes destacaba una intervenci&#243;n quir&#250;rgica por una fractura mandibular ipsolateral 40 a&#241;os antes&#46; La paciente no presentaba s&#237;ntomas sist&#233;micos&#44; negaba la aplicaci&#243;n t&#243;pica o la ingesta de f&#225;rmacos y no identificaba otros posibles desencadenantes&#46; En la exploraci&#243;n f&#237;sica se observ&#243; un eritema y tumefacci&#243;n del pabell&#243;n auricular izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a> A y B&#41;&#44; sin otros signos cut&#225;neos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Con estos hallazgos cl&#237;nicos&#44; y descartadas otras posibles causas&#44; la paciente fue diagnosticada de un SOR&#46; Se inici&#243; tratamiento conservador con medidas f&#237;sicas como la aplicaci&#243;n de fr&#237;o local y antiinflamatorios no esteroideos&#44; con una buena respuesta&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El SOR fue descrito por primera vez por Lance<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> en 1994&#46; Cl&#237;nicamente&#44; se caracteriza por unos episodios parox&#237;sticos de enrojecimiento y dolor o quemaz&#243;n del pabell&#243;n auricular&#44; que puede irradiar a la mejilla&#44; la mand&#237;bula o la zona occipital ipsolateral&#46; Hasta un 60&#37; de los casos presentan episodios unilaterales&#44; un 30&#37; bilaterales y un 10&#37; alternantes&#46; Los episodios suelen durar desde pocos minutos a horas&#44; con una frecuencia variable&#44; y pueden producirse espont&#225;neamente o despu&#233;s de un est&#237;mulo f&#237;sico como cepillarse&#44; lavarse los dientes&#44; masticar&#44; manipular la oreja o movilizar las cervicales<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La inervaci&#243;n sensitiva de la oreja es compleja&#46; La regi&#243;n anterosuperior del pabell&#243;n auricular y el trago est&#225;n inervados por el nervio auriculotemporal &#40;rama colateral de la divisi&#243;n mandibular del nervio trig&#233;mino&#41;&#46; El l&#243;bulo y la regi&#243;n posteroinferior est&#225;n inervados por el nervio auricular mayor &#40;rama del plexo cervical superficial formado por anastomosis de las ramas cervicales C2-C3&#41;&#46; La irrigaci&#243;n vascular deriva principalmente de las ramas de la arteria car&#243;tida externa &#40;arterias temporal media y auricular posterior&#41;&#44; que a su vez est&#225; inervada sensorialmente por el nervio trig&#233;mino<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a>&#46; El mecanismo de control vasomotor de la piel auricular deriva principalmente de variaciones del tono simp&#225;tico y&#44; en un segundo lugar&#44; del tono parasimp&#225;tico&#46; Es probable que el enrojecimiento observado en el SOR sea el resultado de una vasodilataci&#243;n excesiva secundaria a una desregulaci&#243;n producida por la activaci&#243;n de las fibras parasimp&#225;ticas y la inhibici&#243;n del tono simp&#225;tico<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El SOR se divide en s&#237;ndrome primario y secundario&#46; En 2013 Lambru et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> propusieron unos criterios cl&#237;nicos para el diagn&#243;stico del SOR primario &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; El primario normalmente se describe en mujeres j&#243;venes con episodios migra&#241;osos&#44; durante los pr&#243;dromos o durante los ataques&#46; Entre los mecanismos etiopatog&#233;nicos subyacentes del SOR primario se ha propuesto una disfunci&#243;n de los nervios perif&#233;ricos cervicales o de los nervios centrales de las v&#237;as trig&#233;mino-auton&#243;micas&#46; Por otro lado&#44; el SOR secundario se describe con mayor frecuencia en mujeres de mayor edad sin antecedentes de migra&#241;a&#46; Pueden estar asociados a lesiones org&#225;nicas intracraneales o cervicales&#44; trastornos de la articulaci&#243;n temporomandibular&#44; s&#237;ndrome tal&#225;mico&#44; herpes z&#243;ster&#44; adenoma pleomorfo de cuerpo carot&#237;deo y toxicidad secundaria a f&#225;rmacos como la citarabina<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">En el diagn&#243;stico diferencial debemos incluir la policondritis recidivante&#44; la dermatitis de contacto&#44; el herpes z&#243;ster y la erisipela<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a>&#46; Tambi&#233;n debemos considerar la urticaria por presi&#243;n y el <span class="elsevierStyleItalic">flushing</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">El tratamiento se dirige a la causa subyacente y al alivio de los s&#237;ntomas&#46; En general&#44; los resultados terap&#233;uticos son poco satisfactorios&#46; Entre las medidas conservadoras se incluyen la terapia f&#237;sica&#44; aplicando fr&#237;o local o compresi&#243;n manual var&#237;as veces al d&#237;a&#44; los movimientos cef&#225;licos y el uso de f&#233;rulas dentales&#46; Entre los tratamientos t&#243;picos se incluyen los emolientes&#44; los corticoides y los inhibidores de la calcineurina&#46; Los tratamientos sist&#233;micos se suelen reservar para los casos muy sintom&#225;ticos o asociados a episodios de migra&#241;a&#46; Se han utilizado los antiinflamatorios no esteroideos&#44; los antidepresivos tric&#237;clicos&#44; los agonistas y antagonistas serotonin&#233;rgicos&#44; los betabloqueantes&#44; los bloqueadores del canal del calcio&#44; diferentes antiepil&#233;pticos y la ivermectina por v&#237;a oral&#46; Finalmente&#44; en los casos m&#225;s intensos&#44; se han descrito procedimientos invasivos mediante inyecciones de toxina botul&#237;nica o bloqueos nerviosos con anest&#233;sicos locales<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el SOR es una enfermedad rara y poco conocida por los dermat&#243;logos&#46; Es fundamental descartar otras entidades cl&#237;nicas&#44; as&#237; como causas subyacentes&#44; mediante una anamnesis dirigida que recoja los antecedentes m&#233;dico-quir&#250;rgicos y una exploraci&#243;n f&#237;sica exhaustiva&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Q&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#44; Q&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#44; Q&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n de los brotes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&#47;h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frecuencia de los brotes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brote &#250;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brote &#250;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Afectaci&#243;n auricular&#58;U o B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U &#62; B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#62; U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#62; U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B &#62; U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otros signos cut&#225;neos distintos del eritema y la tumefacci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Condritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Descamaci&#243;n y ves&#237;culas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ves&#237;culas y costras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Supuraci&#243;n y puerta de entrada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cl&#237;nica sist&#233;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fiebre&#44; condritis nasal o de la v&#237;a a&#233;rea y poliartritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eczemas en otras localizaciones corporales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desencadenantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Est&#237;mulo f&#237;sico sobre la zona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Productos t&#243;picos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eczema seborreico o picadura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estr&#233;s&#44; alcohol o cambios de temperatura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagn&#243;stico diferencial del eritema y tumefacci&#243;n auricular</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
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        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The mystery of one red ear"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;W&#46; Lance"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Neurol&#46;"
                        "fecha" => "1994"
                        "volumen" => "31"
                        "paginaInicial" => "13"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7586661"
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              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Red ear syndrome&#58; Case series and review of a less recognized headache disorder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Patel"
                            1 => "D&#46; Desai"
                            2 => "S&#46; Desai"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/aian.AIAN_1_20"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Indian Acad Neurol&#46;"
                        "fecha" => "2020"
                        "volumen" => "23"
                        "paginaInicial" => "715"
                        "paginaFinal" => "718"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33623284"
                            "web" => "Medline"
                          ]
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            2 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Red ear&#58; Syndrome or symptom&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46;L&#46; De Amorim"
                            1 => "L&#46;A&#46; Kauppila"
                            2 => "I&#46;P&#46; Martins"
                          ]
                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/head.13333"
                      "Revista" => array:6 [
                        "tituloSerie" => "Headache&#46;"
                        "fecha" => "2018"
                        "volumen" => "58"
                        "paginaInicial" => "885"
                        "paginaFinal" => "891"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29802637"
                            "web" => "Medline"
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            3 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The red ear syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Lambru"
                            1 => "S&#46; Miller"
                            2 => "M&#46;S&#46; Matharu"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1129-2377-14-83"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Headache Pain&#46;"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24093332"
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              "etiqueta" => "5"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "S&#237;ndrome de la oreja roja&#58; un nuevo caso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Arjona"
                            1 => "E&#46; Fern&#225;ndez-Romero"
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                    0 => array:2 [
                      "doi" => "10.1016/s0014-2565(00)70051-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp&#46;"
                        "fecha" => "2000"
                        "volumen" => "200"
                        "paginaInicial" => "704"
                        "paginaFinal" => "705"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11234486"
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Article information
ISSN: 00017310
Original language: Spanish
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Idiomas
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