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Illustration 1. The patient, a 54-year-old woman with Sjögren's syndrome with sicca symptoms, peripheral neuropathy, and somatic patchydyshidrosis, developed otalgia in her left ear. The leukocyte count, C-reactive protein level, and erythrocyte sedimentation rate were all normal, and the patient was negative for antinuclear, anticardiolipin, antineutrophil cytoplasmic, and anti–type II collagen antibodies. The left auricle was painful but not inflamed. However, reddening and dilated capillaries in the left auditory meatus and eardrum were found (A) (arrows), resulting in otitis externa and myringitis. Steroid therapy relieved the pain, as well as the otitis externa and myringitis (B) to some extent, and the associated sensorineural hearing loss also resolved. Over the last several years, the patient's otalgia has recurred in cycles that have paralleled the worsening and improvement of the symptoms and signs of her Sjögren's syndrome, but systemic inflammation has not occurred.

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