Vol 24, No 9 (2022)


Repurposed antimicrobial and antiviral drugs for COVID-19 treatment: safety and side effects in real clinical practice (scientific review)

Leonova M.V.


The COVID-19 pandemic has posed a challenge for new etiotropic agents, leading to an urgent repurposing of antimicrobial and antiviral drugs to treat a new infection based on the results of in silico, in vitro, in vivo experimental studies, and clinical trials. However, less attention has been paid to the safety of repurposed drugs. Exposure to repurposed drugs with limited risk-benefit evidence in COVID-19 required adaptation of safety monitoring, which affected the completeness and quality of reports, and making causality assessments the most difficult task. A review of data accumulated over the period of the COVID-19 pandemic on the nature of adverse reactions associated with the use of repurposed drugs (hydroxychloroquine, chloroquine, remdesivir, favipiravir, lopinavir/ritonavir, ribavirin) used in real practice is presented. The results of RCTs and observational studies, systematic reviews and meta-analyses were used. Systematized data on the safety of the use of hydroxychloroquine and chloroquine in patients with COVID-19 in short-term treatment (≤14 days), including a series of meta-analyses, the risk of adverse effects was increased by 1.5–2 times; the main manifestations are prolongation of the QT interval and arrhythmias (up to 25%), gastrointestinal disorders (up to 50%), increased levels of bilirubin (3%) and transaminases (up to 10%), dermatological (up to 10%) and neuropsychiatric side effects (up to 21.7%). Most of the side effects of repurposed antiviral drugs of the nucleoside analog group are associated with their direct cytotoxic effect, which is manifested by toxic damage to the gastrointestinal tract, hepatotoxicity, nephrotoxicity, cardiotoxicity, and hematotoxicity. The greatest number of side effects from the gastrointestinal tract and liver were observed for lopinavir/ritonavir in comparison with other drugs. New side effects have been identified for remdesivir when used in the context of the COVID-19 pandemic – cardiotoxicity (bradycardia and severe hypotension) and nephrotoxicity, which was regarded by regulatory authorities as a “safety signal”. To solve the problems of assessing the cause-and-effect relationship, further more thorough research and analysis will be required. The accumulated information in the context of the ongoing COVID-19 pandemic should be subject to ongoing dynamic analysis and published in medical journals to alert clinicians.

Consilium Medicum. 2022;24(9):567-573
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Voice changes during the COVID-19 pandemic: A review

Radtsig E.I., Egina A.D.


The article addresses the issue of voice changes during the COVID-19 pandemic in patients and convalescents and briefly presents information on voice disorders are their causes. According to the literature, voice changes (phonasthenia, dysphonia, and aphonia) are not uncommon in patients with coronavirus infection, although less common than the typical COVID-19 symptoms, and the incidence of voice change is proportional to the disease severity and can persist in convalescents. Therefore, it requires an additional emphasis on identifying the cause of this symptom and proper treatment/medical rehabilitation of such patients. In the context of treatment in patients with various voice disorders, both functional (phonasthenia) and organic (dysphonia/aphonia), Homeovox can be helpful since its effectiveness has also been proved in treating laryngitis associated with the new coronavirus infection.

Consilium Medicum. 2022;24(9):575-578
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Efficacy of herbal medicines in the treatment of acute respiratory infections in real clinical practice

Svistushkin V.M., Nikiforova G.N., Shevchik E.A., Zolotova A.V., Nikiforova A.N., Sivokhin D.A.


Background. Unreasonable prescription of antibiotics to patients with acute diseases of the upper and lower respiratory tract is a significant problem of modern medicine, as it is associated with a high risk of side effects, an increase in antibiotic resistance and high economic costs. Phytopreparations can help reduce the frequency of inadequate antibiotic prescribing.

Aim. To study the effect of the use of herbal medicines on changing the frequency of prescribing antibiotic drugs to patients with infectious respiratory pathology. In addition, the presence of a relationship between the appointment of phytopreparations and the duration of the course of the infectious and inflammatory process was determined.

Materials and methods. Materials from the IMS® Disease Analyze database were analyzed. The study included patients who were diagnosed with acute respiratory infection between January 2015 and March 2019. According to the prescribed treatment, patients were divided into two groups: the main one, whose patients were prescribed phytopreparations as therapy, and the control group without the appointment of similar treatment. Patients who were prescribed antibiotics on the day of diagnosis were excluded from the study. To assess the relationship between the prescription of phytopreparations, antibiotics and the duration of the period of temporary disability, the logical regression method was used.

Results. The first group included 117 182 patients who used herbal medicines. In the control – the same number of patients without the appointment of phytopreparations. The following results were obtained: the use of phytopreparations was accompanied by a rarer additional prescription of antibiotics in the process of treatment, the duration of the period of temporary disability in the main group was shorter.

Conclusion. The use of phytopreparations in acute respiratory infections statistically significantly causes a decrease in the frequency of prescribing systemic antibiotics and a decrease in the duration of the period of temporary disability.

Consilium Medicum. 2022;24(9):579-587
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Virucidal efficacy of cetylpyridinium chloride and benzydamine hydrochloride fixed combination lozenges against influenza A virus: A review

Filippova O.V.


Cetylpyridinium chloride (CPC) is effective against respiratory viruses, including influenza. Septolete® Total, lozenges containing CPC and benzydamine, demonstrated virucidal activity against influenza A virus, higher than CPC alone.

Consilium Medicum. 2022;24(9):588-594
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The possibilities of wide-range MSCT in assessing the invasion of mediastinal structures in giant neoplasms of the thoracic organs

Koroleva I.M., Parshin V.D., Mukhamatullina E.Z., Mishchenko M.A.


Despite the constant increase in the level of equipment of medical institutions with modern high-tech equipment (CT, MRI, endoscopes, etc.), in the last decade there has been a clear trend towards an increase in the number of patients with tumors of intra-thoracic localization, including giant sizes. Oncologists consider neoplasms that occupy more than half of the hemithorax or simultaneously spread to the anterior and posterior mediastinum to be giant tumors of the chest. According to leading oncologists, giant tumors should include chest tumors whose diameter is equal to or exceeds 20 cm, have different initial localization, more than 80% of cases have different histological affiliation. There is no unity of views of leading oncologists and thoracic surgeons on the classification of giant intra-thoracic formations, diagnosis, determination of their initial localization and, accordingly, determination of the possibility of their surgical treatment and selection of optimal access. It is not uncommon when issues related to the initial localization, histological affiliation, as well as invasion of surrounding structures are resolved during surgical intervention. Unfortunately, there is little information in the Russian scientific literature about the high-tech diagnosis of this group of neoplasms, then malignant formations are twice as common as benign ones. Given the prevalence of malignant neoplasms in the category of giant tumors of intra-thoracic localization, a very relevant diagnostic issue is the identification of invasion of mediastinal structures, which largely determines both the feasibility of surgical intervention and its possible variants.

Consilium Medicum. 2022;24(9):595-601
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The effectiveness of the use of superelastic nitinol stapedial prostheses in comparison with titanium ones in the surgical treatment of patients with otosclerosis

Diab K.M., Daikhes N.A., Pashchinina O.A., Kokhanyuk S.V., Smirnova A.V., Zukhba A.G.


This article presents the results of a comparative evaluation of surgical treatment of patients suffering from conductive and mixed hearing loss in various clinical forms of otosclerosis using titanium and nitinol stapedial prostheses.

Materials and methods. In the department of surgical treatment of diseases of the ear and the base of the skull of the NMICO from 2017 to 2020, the functional results of stapedoplasty using titanium and nitinol prostheses were compared in the near (up to 3 months) and long-term (more than 6 months) postoperative period. The comparison groups included 50 patients who were divided into two equal in all major indicators groups that differ only in the type of prosthesis used (SE NiTiNOL/PTFE and Ti/PTFE). In the postoperative period (the average follow-up period was 3 years), the values of the bone-air interval in operated patients were evaluated; clinical and experimental comparison of computed tomography data obtained during the installation of titanium and nitinol prostheses was also carried out.

Results. Functional results were assessed in the immediate (1–3 months) and long-term (6 months–3 years) periods after surgery. The average postoperative CVI was 12.29 dB (SD ± 5 dB) in patients in the group with nitinol prostheses and 11.93 dB (SD ± 5 dB) in titanium. 88% and 80% of patients in both groups had an "excellent" or "good" result in hearing improvement.

The cadaveric material was used to compare the CT data obtained during the installation of stapedial prostheses: in 4 cases, when installing a nitinol prosthesis, there were no artifacts, which made it possible to visualize the prosthesis attachment ring; in the other 4 cases with a titanium prosthesis, this was not possible to detect.

Conclusions. The installation of a nitinol prosthesis has a number of advantages: it does not require additional fixation of its head on the long stem of the anvil in the form of a “compression”, which minimizes the risks of traumatizing the structures of the inner ear and, accordingly, the development of sensorineural hearing loss in the postoperative period, as well as the use of SENiTiNOL prostheses reduces the likelihood of developing aseptic necrosis of the long leg of the anvil due to the properties of the metal and a decrease in its thickness. Analyzing the data of computed tomograms of patients after stapedoplasty, only in the group with installed nitinol prostheses, it was possible to visualize the position of the prosthesis on the long stem of the incus, in the area of the vestibule, its length, the integrity of the long stem of the incus.

Consilium Medicum. 2022;24(9):603-608
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Adenoma of middle ear: clinical case

Saydulaev V.A., Diab K.M., Daikhes N.A., Garashchenko T.I., Yunusov A.S., Pashchinina O.A., Umarov P.U.


Tumors in the middle ear rarely have an adenomatous nature. Adenomatous tumors can manifest as neuroendocrine adenoma, endocrine adenoma and middle ear adenoma (or temporal bone adenoma). They may represent the same tumors at different stages of glandular and neuroendocrine differentiation. Middle ear adenoma refers to rare tumors. The tumor can clinically manifest itself with nonspecific symptoms, which makes timely diagnosis difficult. According to computed tomography and magnetic resonance imaging, a soft-tissue tumor with clear boundaries usually is detected in the middle ear, without destructive changes and spreading beyond the middle ear. Usually no difference between adenoma and other middle ear tumors, which makes differential diagnosis difficult. The final diagnosis is usually made according to the histological examination. Surgery is the main method of treatment of middle ear adenoma, the purpose of which is radical resection of tumor.

Consilium Medicum. 2022;24(9):609-611
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Allergic rhinitis and comorbid diseases. Otorhinolaryngologist’s view. Case report

Shilenkova V.V.


Comorbid diseases aggravate allergic rhinitis (AR), require additional examination and correction of treatment. The article presents a review of publications on the relationship of AR with adenoid and exudative otitis media (EOM). The analysis confirmed the fact of more significant hypertrophy of the nasopharynx tonsil and more pronounced nasal obstruction in children with AR compared to children without atopy, more severe course of AR in children with adenoid. Early control of allergy reduces the need for adenoidectomy, but surgery cannot be the first step because it does not cure AR. After adenoidectomy, patients should be closely monitored to control allergy symptoms. The analysis of publications did not allow to establish a reliable relationship between AR and EOM. However, comorbidity is supported by a significant prevalence of EOM in children with AR (25%), a high level of eosinophilic cationic protein and immunoglobulin E in the exudate of the middle ear, which requires an attempt at conservative treatment of AR before tympanostomy. Despite the variety of drugs to control AR, oral non-sedating antihistamines are still the first line of therapy. A special place is occupied by the Quinuclidine derivative Hifenadin (Fenkarol®), which combines the advantages of I and II generations of antihistamines. Along with cholinolytic, ganglioblocking and antiserotonin effects, due to its low lipophilicity, Fenkarol® does not penetrate the blood-brain barrier, does not potentiate the sedative effect, which makes it in demand not only in dermatoses, but also in AR, which was demonstrated by clinical observation.

Consilium Medicum. 2022;24(9):612-616
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Esthesioneyroblastoma. Retrospective analysis of 10 observations

Ognerubov N.A., Antipova T.S., Ognerubova M.A.


Background. Esthesioneyroblastoma is a rare malignant tumor arising from olfactory neuroepithelium of the nasal cavity. It is an aggressive local tumor. It accounts for 3 to 6% of cases of nasal and sinus cancer. Occurs at any age. Due to the rarity of the disease, there are no uniform standards of treatment. A multimodal and interdisciplinary approach is recommended.

Aim. To present the results of a retrospective study of patients with esthesioneuroblastoma.

Materials and methods. The retrospective study was carried out using the database of departments of radionuclide diagnostics of Nuclear Medicine Centres from 2012 to 2022. Ten patients with histologically confirmed diagnosis of esthesioneyroblastoma were identified.

Results. Age of patients from 29 to 67 years, median – 51 years. Men and women – equal. The clinical picture was dominated by a sense of nasal congestion and various nose impairments – 8 and 7 patients. The tumor was more often confined to the left side of the nose. Computer tomography (CT), magnetic resonance imaging and positron emission tomography combined with CT (PET/CT) were used for diagnosis, estimation of tumor process prevalence and outpatient observation. Stage A by Kadish was identified in 2 cases, and stage B – in 1 patient. Stage C – 6 patients predominated. D was diagnosed in 1 patient. The use of PET/CT clarifies the primary stage, the effect of therapy, provides disease control during dynamic observation. The SUVmax median for primary tumor was 7.43 (4.3–19.1). A multi-modal approach is used to treat esthesioneuroblastoma. The surgical method is performed by 4 patients with subsequent radiation therapy. Radiation therapy was carried out at the first stage of 3 patients, the total focal dose was 66 Gy. Polychemotherapy followed by radiotherapy was used in 3 cases. Duration of observation ranged from 8 to 108 months, median – 47.5 months.

Conclusion. Esthesioneyroblastoma is a rare malignant nasal tumor. The peak of the disease falls on 50–70 years. No gender differences have been identified. The main clinical symptoms are nasal congestion – 8 patients and various smelling disorders – 7 patients. PET/CT is the main imaging method in the diagnostic, evaluation and observation phases. In this case, most often (6 patients) is determined stage C by Kadish.

Consilium Medicum. 2022;24(9):618-624
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Ways of penetration of glucocorticosteroids from the tympanic cavity to the structures of the inner ear: A review

Blinova M.L., Golovanov A.E., Isachenko V.S.


To date, in domestic and foreign literature, there are more and more reports of the successful use of glucocorticosteroids for the treatment of pathology of the inner ear by local – intratympanic administration. Many methods are being developed to deliver drugs to the structures of the inner ear. As you know, the systemic administration of glucocorticosteroids has a number of contraindications and a large number of side effects, due to a wide spectrum of action. Exogenous glucocorticoids disrupt the natural balance of the hypothalamic-pituitary-adrenal system, interfering with the negative feedback regulation system, which requires a long time to fully restore. The intratympanic method of administering glucocorticosteroids makes it possible to bypass the above undesirable effects and at the same time provide the desired therapeutic effect on the vestibular and cochlear structures of the inner ear. With regard to the effect on the structures of the inner ear, intratympanic use of glucocorticosteroids turned out to be more effective than the systemic one, which is associated with the presence of a hematoperilymphatic barrier, comparable in its permeability to the blood-brain barrier. Moreover, when administered systemically, large doses of steroids are required to achieve a sufficient concentration of the drug in the fluids of the inner ear. To date, many questions remain regarding the routes by which the drug penetrates to the structures of the inner ear, the principles of distribution of the drug within the cochlear fluids, as well as the anatomical obstacles that may be encountered on the way to achieving the desired therapeutic effect. The purpose of this article is to highlight the current achievements in the field of research on the routes of penetration of drugs, in particular glucocorticosteroids, to the structures of the inner ear from the tympanic cavity.

Consilium Medicum. 2022;24(9):626-631
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Cerebral venous thrombosis in otorhinolaryngology. Case report

Krivopalov A.A., Shcherbuk A.Y., Shcherbuk Y.A., Sarkisyan I.I., Shamkina P.A., Glyshchenko A.I.


A violation of cerebral circulation, in which a blood clot forms in the venous system of the brain with the formation of an obstruction of the dural sinus, one or more veins of the brain is called cerebral venous thrombosis. Cerebral venous sinus thrombosis (CVT) is a rare venous thromboembolic event, which accounts for 5 cases per 1 million among adults and about 7 cases per 1 million among children, according to the International Study on Cerebral Vein and Dural Sinus Thrombosis. Women of childbearing age are more susceptible to the disease, which is probably due to hormonal changes during pregnancy, labor, as well as the concomitant effect of oral contraceptives (leading to hypercoagulation). In addition to the low prevalence of CVT, the variety of etiology, the diagnosis is complicated by the highly variable clinical picture of cerebral venous thrombosis. The clinical manifestations of CVT are very diverse and depend on the prevalence of thrombosis, the rate of formation of vein occlusion, the age of patients, and the etiological factor. The main symptom of CVT is an intense headache (92%) as a sign of developing intracranial hypertension. During more than 2 years of follow-up, the mortality rate from CVT was calculated – 8.3%, however, in more than 90% of cases the prognosis of the disease is favorable. Despite the favorable prognosis, without timely treatment of CVT, this is a potentially lethal disease, so the relevance of this topic is beyond doubt.

Consilium Medicum. 2022;24(9):632-636
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Fighting against antimicrobial resistance: focus on improving the efficiency of treatment of respiratory infections in outpatient settings


Increasing antimicrobial resistance, including improper antibiotic use, is a global threat to public health. Reducing prophylactic antibacterial (AB) prescriptions in acute respiratory viral infection (ARVI) and reducing the incidence of bacterial complications in patients at risk of severe ARVI is an urgent medical task. For this purpose, Rafamin can be used, which has antiviral and antibacterial effects. The article provides the preliminary results of a large-scale observational study on Rafamin efficacy and safety in treating acute respiratory viral infections in routine outpatient practice. Rafamin was shown to be effective irrespective of the timing of treatment initiation – with early and delayed treatment initiation. The AB prescription rate was low (0.8%) and did not increase in patients who started taking Rafamin a few days after the onset of the first disease symptoms. The data obtained are promising for treating patients at risk of severe respiratory infection. Rafamin may reduce the rate of improper AB prescribing and antibiotic resistance rate.

Consilium Medicum. 2022;24(9):638-639
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Idiopathic pulmonary fibrosis: a clinical case of long-term follow-up

Ignatova G.L., Blinova E.V., Belsner M.S., Korotkaia M.A.


Idiopathic pulmonary fibrosis is a specific form of chronic progressive fibrotic interstitial pneumonia of unknown etiology. Over the past decade, significant progress has been made in developing and utilizing a diagnostic algorithm for patients with idiopathic pulmonary fibrosis, involving analysis of clinical, laboratory, and instrumental data, primarily the results of high-resolution chest computed tomography. Early antifibrotic therapy can alter the disease course, slow its progression, and improve the prognosis.

Consilium Medicum. 2022;24(9):640-644
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Clinic and diagnosis and comorbidity of respiratory tuberculosis and viral pneumonia caused by Herpes simplex virus, Cytomegalovirus Human and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency

Mishin V.Y., Mishina A.V., Lezhnev D.A., Sobkin A.L., Shashenkov I.V.


Aim. To study the features of the social status, clinic and diagnosis of respiratory tuberculosis comorbidity and viral pneumonia caused by Herpes simplex virus type 1, Cytomegalovirus Human and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency.

Materials and methods. The prospective study included 25 patients with respiratory tuberculosis comorbidity with Mycobacterium tuberculosis, herpesvirus and coronavirus pneumonia, and 21 patients with respiratory tuberculosis with cytomegalovirus and coronavirus pneumonia (1a and 2a main groups) and, respectively, 25 and 21 similar patients, but without coronavirus pneumonia (1b and 2b comparison group), in the late stages of HIV infection with immunodeficiency. For the etiological diagnosis of herpesvirus- and cytomegalovirus pneumonia, PCR was used to detect the DNA of Herpes simplex virus type 1 and Cytomegalovirus Human in the diagnostic material of the respiratory tract, and for the etiological diagnosis of coronavirus pneumonia, PCR was used to detect SARS-CoV-2 RNA. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval.

Results. The comorbidity of respiratory tuberculosis, herpes-, cytomegalo- and coronavirus pneumonia in patients with late-stage HIV infection, in the phase of progression and in the absence of ART was characterized by severe immunodeficiency and generalization of tuberculosis with multiple extrapulmonary lesions. This determines the similarity of clinical manifestations and visualization of CT changes in this comorbidity, which makes it difficult to distinguish them due to the simultaneous layering of several pathologies with the same type of clinical manifestations at once and requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients.

Conclusion. Patients with tuberculosis of the respiratory system and HIV infection registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of infection with COVID-19 and CVP disease, and with severe immunodeficiency and GWP and CMVP, should be regularly subjected to preventive studies for timely detection of COVID-19 for the purpose of their emergency isolation and treatment.

Consilium Medicum. 2022;24(9):645-650
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A new approach in the treatment of chronic bilateral paralytic stenosis of the larynx: A review

Panchenko P.I., Krivopalov A.A., Shamkina P.A., Mazeina E.S.


The issues of surgical treatment of bilateral paralytic stenosis of the larynx do not lose their relevance today, since the proportion of patients suffering from this pathology is steadily increasing. Neurogenic disorders of laryngeal motor function most often occur due to previous surgical intervention on the thyroid gland and upper mediastinum. The predominant complaints of such patients are dyspnea, decreased tolerance to physical exertion and impaired lantern function. Thus, the main objectives in the treatment of chronic laryngeal stenosis are: restoration of the lumen of the vocal slit to ensure adequate respiratory function, prevention of respiratory failure and preservation of socially significant voice. The use of semiconductor lasers for laryngoplasty in bilateral paralytic stenoses of the larynx is a very common technique, however, there are no data in the literature on the use of semiconductor laser energy with a wave length of 445 nm for this surgical intervention. In their work the authors tried to show the advantages of the surgical treatment of bilateral paralytic laryngeal stenosis using 445 nm semiconductor laser, developed at the Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, which allowed to reduce rehabilitation period of respiratory function and preserve socially significant voice, using a clinical example.

Consilium Medicum. 2022;24(9):651-654
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Nasopharyngeal sarcoidosis: a clinical case

Sapova K.I., Gaydukov S.S., Voronov A.V., Naumenko A.N., Sarkisyan I.I.


Sarcoidosis is a chronic multisystem inflammatory disease characterized by non-caseous granulomas, most commonly in the lungs and intrathoracic lymph nodes. The nasopharyngeal disease is a rare localization of sarcoidosis. Clinical presentations include difficulty in nasal breathing, rhinophonia, and postnasal syndrome. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging are the main diagnostic methods for detecting lesions in this area. The histological examination provides the diagnosis verification. Considering the frequent secondary spread of sarcoidosis, all patients should consult a rheumatologist to select adequate systemic therapy. We provide a clinical case illustrating the management of a patient with nasopharyngeal sarcoidosis.

Consilium Medicum. 2022;24(9):655-658
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Hyperacusis in children: A review

Levina E.A., Levin S.V., Khramov A.V., Sugarova S.B., Voronov V.A.


The problem of hyperacusis – a condition in which sensitivity to sounds is increased – is common in world practice. According to the ICD classification of diseases of the World Health Organization (WHO), the concept of “hyperacusia” is used as a general term for abnormal auditory sensations, (ICD code H93.2). Up to 17% of children and adolescents are disturbed by unpleasant sensations in the sounds of the environment. In this review, we would like to analyze the current state of the issue, to understand the terminology of similar conditions. To study the nature of complaints, varieties and causes of this condition, the relationship with concomitant diseases. Designate diagnostic principles, algorithms for managing patients with hyperacusis by different specialists. Consider the options for the treatment and rehabilitation of children and adolescents suffering from hyperacusis proposed in world practice.

Consilium Medicum. 2022;24(9):659-664
pages 659-664 views

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