|Year : 2015 | Volume
| Issue : 1 | Page : 1-4
Holistic approach to deafness
MK Taneja1, Sameer Qureshi2
1 Editor-in-Chief, IJO, Indian Institute of Ear Diseases, Muzaffarnagar, New Delhi, India
2 Department of Otorhinolaryngology, Jinnah Post Graduate Medical College, Karachi, Pakistan
|Date of Web Publication||10-Mar-2015|
M K Taneja
Editor-in-Chief, IJO, Indian Institute of Ear Diseases, Muzaffarnagar, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Taneja M K, Qureshi S. Holistic approach to deafness. Indian J Otol 2015;21:1-4
Hearing is an essential sense of an individual, which is crucial for verbal communication and social living. With increasing noise pollution, ototoxic drugs, ototoxic chemicals the incidence of old age deafness is on increase. WHO estimates 360 million individuals in the world have disabling hearing loss, of which 91% are adults and only 9% are children.  Disabling hearing loss is >40 dB hearing loss in better ear in a person above the age of 15 years and >30 dB in better ear below the age of 15 years. 
The noise, diabetes, cervical spondyliosis, hypertension, hypothyroidism, obesity, sinusitis, Eustachian tube More Details dysfunction ototoxicity of drugs and chemicals are the few which aggravate the age related sensorineural deafness (presbyacusis). Noise induced hearing loss is 100% preventable, but once the patient had it, is for life time. 
With the increasing life span we expect the prevalence of deafness as high as 40% above the age of 75 years.  The worst part of this deafness is it affects speech frequencies hence only 20% will be benefited even with the best possible hearing aids. This huge population of senior citizen will be a big liability and great national loss. Hence, we have to make all the efforts to prevent this aging hearing loss and if curable to cure it. Remember even 5 dB of improvement is a great improvement in terms of speech discrimination as 5 dB is not simple 5% dB (decibel) is an octave meaning 5 times.
We have to do a massive awareness program to ignite the middle-aged persons to go for periodic check-up, government, corporate sectors, nongovernmental organizations, social activists and volunteers should actively participate in it. We have to launch an awareness program how to prevent this progressive hearing loss. It is all the more important in patients of presbyacisis who have familial incidence or working in noisy environment.
The workers of printing press, fuelling station (petrol pump), basic metal industries, chemical industries, pesticides and lead industry are at two-fold higher risk due to noise pollution and chemical toxicity, hence these workers should be made aware and prevented from this preventable hearing loss.
In all age-related deafness, what we usually as a otolaryngologist/audiologist do, get the audiogram done and prescribe a hearing aid, but what is required, firstly we have to console him and perform a thorough examination and try to find out any associated factor, ratification of cause can provide him some improvement for which usually a multi-disciplinary holistic approach is necessary.
In general examination we have to look for nutritional deficiency, especially for anemia, Vitamin D deficiency. Edentulous senior citizen if encouraged and provided with denture, the quality of life increases many fold apart from hearing.
Diabetes, incomplete control and management aggravate the neuropathies and hair cells (inner ear) damage.
| Hypothyroidism|| |
Uncontrolled hypothyroidism and iron deficiency is a known cause of deafness its control can lead to some improvement in hearing, addressing to hypothyroidism may also further improve hearing by correcting obesity leading to better Eustachian tube function and restoring normal middle ear pressure.
| Holistic Approach to Deafness|| |
In majority of cases we can provide some improvement in sensorineural deafness if not at least we can improve the quality of life by multi factorial approach.
| Yoga|| |
Various yoga aasana's are helpful in restricting the progressive hearing loss:
- Greeva Chalan
- Skandh Chalan
- Bhramari Pranayam
Greeva Chalan (neck exercise)
With the growing age there is some degree of reduced blood supply to brain and labyrinth by compression of vertebral artery due to cervical spondyliosis, which can be minimized by regular cervical (neck) and shoulder exercises.
It is a set of three exercises:
- First exercise is cervical or neck flexion extension exercise. Start the exercise by tucking the chin in to the chest by gently bringing the head downward. Next gently band the head backward let it go maximum with ease
- Second exercise is lateral flexion try to touch your right ear to right shoulder then left ear to left shoulder perform alternatively. Do not turn or rotate your head
- Third exercise is rotate your head first to the right, go back to neutral position then to left gently try to rotate to your maximum.
All these three exercises are performed to the maximum but with ease no overstretching or pain.
Second set of three exercises are performed in the same way but we do not move the head but apply the counter pressure on head by hand to stretching neck muscles.
Last neck exercise should be performed initially in sitting posture by rotating the head on neck all 360° starting from tucking the chin into the chest swimming to right shoulder to back then going to left side and coming back forward and downward.
Complete three sets and repeat three sets doing by rotating the left side.
Sit comfortably on chair or edge of bed preferably in Sukhasana, put both hand on both knees. Rotate your both shoulder first forward then upward then backward and then downward completing one cycle. Do it 20 times.
Now do alternate rotation when your right shoulder is up and left shoulder is down and when right is forward the left is backward. Do it 20 times.
All the asana give better result if performed on after holding a deep breath.
Bhramari Pranayama (bee breath)
It is a breathing exercise, a humming sound is produced during exhalation with an effort to generate the echo in the ears.
In modern medicine higher frequency sounds (ultrasound therapy) is a known modality in treatment of tinnitus and sensorineural deafness.
Apart from restoration of hearing by stimulating the hair cells and generating action potential, is also quite effective in destressing.
The exercise can be performed sitting comfortably in calm places with eyes closed, relaxed mood with a smile on face, place your index finger gently in the ear canal or on tragal cartilage, gently block the ear canal. Take a deep breath and as you exhale slowly made a loud humming sound and generate echo, focus your attention towards the inner ears. A high pitch sound gives better results. It also helps in regaining better speech recognition.
Shanmukhi mudra is modification of Bhramari mudra for better and earlier improvement. Procedure is place your both thumbs at tragal cartilage or at inlet of external auditory canal, both hands index fingers on the forehead just above the eyebrows, middle fingers on the eyes, ring fingers on the nostril and little finger on upper lip. A high pitch humming sound is produced.
Kumbhak is a respiratory exercise which can be justified scientifically. Carbogen therapy is a known treatment in cerebral atrophy, sensorineural deafness and Alzheimer's disease. In carbogen therapy, we provide 5% carbon dioxide (CO 2 ) as a stimulant and in Kumbhak we exhale the air from the lungs for the maximum time and capacity hence we increase the blood CO 2 level which leads to stimulation and regeneration of higher centers including hearing area.
In this exercise as shown in posture, sitting comfortably in Sukhasan or on chair with straight trunk and spine, index and middle finger rest on the forehead between the eyebrows and thumb on right ala of nose and right ring finger tip on left ala of nose. The exercise starts with slow, gradual deep inhalation from right nostril counting the digits 1 to 10 (duration 1-time) filling the lungs entirely. The breath is kept on hold by closing both nostrils and counting 11-50 (duration 4 times), followed by exhalation counting 51-70 (2 times) during exhalation right nostril will remain closed by thumb and from life nostril tip of the ring finger will be withdrawn. After deep exhalation every bit of air is drawn out forcefully, both nostrils are closed again for 10 counts from 71 to 80 (1-time). This duration of exercise can be modified as per body strength, and lung capacity, inhalation 1-time, holding 4 times, exhalation 2 times and cessation 1-time this completes one cycle. This cycle has to be repeated many times and 2-3 times in a day.
Right nostril is supposed to increase the blood circulation and vitalize the body known as Surya nadi (Pingala nadi) if Kumbhak is performed only from right nostril is termed as Surya Bheda Pranayama. In this yoga while holding the breath the chin is tucket in the sternum (Jalandhara bandh). It also clears the sinuses and prevents delay the age related decay of aging body and body organs.
| Shankha Naad|| |
Blowing a Shankha (snail pipe) is a powerful respiratory exercise; it tones up the muscles of respiratory passage.
The shape of Shankha (snail shapped) resembles the shape of cochlea. The sound of Shankha is said to stimulate all the hair cells in inner ear hence helps in preventing the aging hearing loss.
By toning up respiratory tract muscles. It helps in reducing the snoring and obstructed sleep apnoca.
| How to Blow Shankha (Conch Shell)|| |
Your back must be straight and your neck upward and slightly backward.
For blowing Shankha take a deep breath and concentrate on blowing, close your eyes, gradually increase the force hence pitch from low to high frequency. Longer is the duration more is the stimulation and more positive energy generated, resulting in prevention of deafness and enforcement in hearing.
Apart from stimulating the ear blowing of Shankha can improve the vital capacity and said to correct the speech defects and respiratory diseases.
Medically Shankha is a good source of calcium magnesium and phosphorous hence water kept overnight is nutritionally good otherwise religiously said to bring fortune (blessing of goddess luxmi).
| Mudras|| |
It is a posture known to increase the power of hearing in normal person and for spiritual awakening. The posture is sitting comfortably preferably in Sukhasan/Padmasan but may be performed sitting on chair with straight trunk and spine. As shown in picture bend the middle finger and its tip should press/dig into the ball/base of thumb. Now gently thumb should press the middle finger, rest of the finger should be strached and straight. Mudra should be done by both hands synchronously. Shunya Mudra is said to be effective in vertigo and thyroid disorder also.
This is a simple mudra, formed by joining the tips together of index and thumb again sitting comfortably as in Shunya Mudra. Apart from regenerating the cerebral cortex and hearing area it is effective in loss of memory, cerebral palsy, diabetes, Alzheimer's disease and hypothyroidism.
| Life Style Changes|| |
Restriction of aggravating factors in diet which increases mucous in the body like dairy products, alcohol, coffee, black tea, processed food prevents deafness.
Avoid exposure to cold and frequent change of temperature, which may aggravate the sinusitis and Eustachian tube dysfunction.
Smoking and tobacco chewing is known to affect hearing hence a wide awareness program should be launched to make the public aware that it does not lead only to malignancy or tuberculosis, it also leads to deafness. Public must be made aware that passive smoking (smoking in the house) may lead to all the complications as to a smoker, may be even more in passive smoker.
Over exhaustive use of mobile phone may lead to hearing loss hence restricting its use prevents sensorineural hearing loss specially in presbyacusis cases. ,
| Diet|| |
Foods rich in omega three fatty acid prevents aging hearing loss, strengthens the blood vessels. Antioxidants and folic acid if cannot cure certainly prevents or delay the progressive hearing loss, common food as fish-salmon, spinach, asparpus, broccoli, beans, liver, eggs, nuts are good source, low level of magnesium in the perilymph. Fluid in the inner ear may cause energy depletion and irreversible damage to the hair cells, banana, potato, broccoli are the sources. Zink supplement is said to prevent aging deafness. Papaya, whole gain, dark chocolate, peas are the source. Vitamin C boosts up immune system available in lemon, oranges, citrus fruits, and Amla (gooseberry embica) are the good source.
Potassium level decreases with age and its depletion affects hearing, bananas, melons, orange and spinach are the source mucus producing foods, dairy product, starch, carbohydrate, processed food alcohol are said to aggregate the aging hearing loss while leafy green vegetables, if not cure prevent the progressive hearing loss. Correction of Vitamin D deficiency corrects the calcium level in labyrinth hence delays age related hearing loss. ,
| Conclusion|| |
There is an increase in old age deafness, up to 40% senior citizen above the age of 75 have a disabling hearing loss one of which only 20% are expected to be benefited with hearing aid. Hence, all efforts should be made to prevent age related hearing loss by avoiding noise, ototoxic drugs chemical and by performing yoga, aasanas by changing diet and life style.
| References|| |
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Taneja MK. Noise-induced hearing loss. Indian J Otol 2014;20:151-4.
Sahoo GC, Sebastian H. Prevalence of sensorineural deafness in habitual mobile phone users. Indian J Otol 2011;17:97-100.
Ramya CS, Karthiyanee K, Vinutha S. Effect of mobile phone usage on hearing threshold: A pilot study. Indian J Otol 2011;18:159-61.
Taneja MK. Role of vitamin D in prevention of deafness. Indian J Otol 2012;18:55-7.
Taneja MK, Taneja V. Vitamin d deficiency in E.N.T. Patients. Indian J Otolaryngol Head Neck Surg 2013;65:57-60.