Indian Journal of Otology

EDITORIAL
Year
: 2016  |  Volume : 22  |  Issue : 3  |  Page : 145--147

Bhramari (Shanmukhi Mudra) Pranayama in presbyacusis and dementia


MK Taneja 
 Senior ENT and Head Neck Surgeon, Indian Institute of Ear Diseases, New Delhi, India

Correspondence Address:
M K Taneja
Senior ENT and Head Neck Surgeon, Indian Institute of Ear Diseases, New Delhi
India




How to cite this article:
Taneja M K. Bhramari (Shanmukhi Mudra) Pranayama in presbyacusis and dementia.Indian J Otol 2016;22:145-147


How to cite this URL:
Taneja M K. Bhramari (Shanmukhi Mudra) Pranayama in presbyacusis and dementia. Indian J Otol [serial online] 2016 [cited 2020 Aug 8 ];22:145-147
Available from: http://www.indianjotol.org/text.asp?2016/22/3/145/187985


Full Text

The World Health Organization (WHO) estimates, aging populations is on the increase in developing countries and along with modernization, deafness, and dementia is going to become epidemic which warrants early intervention to prevent this almost incurable diseases. The preventive measures barely exist in and adopted by the society our country.

The deafness which is one of the most common etiological factors precipitating dementia. Out of 738 crore world population, 36 crore suffer from hearing disability, which is more than 40 dB hearing loss. The WHO estimates that in 2025 there will be 1.2 billion people over the age of 60 years worldwide suffer by presbyacusis.[1],[2] Almost 50% of senior citizens above the age of 75 years suffer from disabling hearing loss.[3] Only 20% of these senior citizens are benefitted with the hearing aid.[4] The hearing loss leads to isolation, depression, and dementia.

Dementia is the general term use to express a decline in mental ability severe enough to interfere with daily life. The person has problem in speaking, orientation of place, lose goods, having mood, and personality changes.

The incidence of Alzheimer's diseases varies in India from 4.7% to 5.34% in senior citizens which is going to increase almost 4 times in next two decades. Hence, we have to identify examine and document the population above the age of 50 years having or prone to hearing impairment to prevent this epidemic of deafness leading to dementia and Alzheimer's diseases.

There is no significant treatment or cure of old age deafness (presbyacusis) or of dementia in modern medicine. The prevention of deafness by Yoga, lifestyle changes including diet and avoiding ototoxic drugs and chemicals may play a big role in it.[5]

Yoga is an ancient discipline to maintain or to bring health to the physical, mental, spiritual, and emotional dimensions of the individual. The National Institutes of Health (USA) has classified yoga as a form of complementary and alternative medicine and considered as a holistic approach to physical and mental health.

Cervical and shoulder exercise, Bhramari Pranayama in Shanmukhi Mudra, Kumbhaka along with Gyan Mudra and Shunya Mudra may play a significant role in prevention. A person of any age in standing, sitting, or lying down position even on a hospital bed can perform humming exercise. A phonatory respiratory exercise releases nitric oxide (NO). NO is a gas molecule, key biological messenger playing an important role in biological processes at the cellular level. Humming (Bhramari) increases the production of NO from sinuses, nasal mucosa, and blood vessels.

NO contributes to nonspecific host defense against bacterial, viral, fungal, and parasitic infections, hence takes care of infection in the body. NO improves ventilation–perfusion ratio in the lung along with the relaxation of bronchial tree smooth muscles; hence, oxygen uptake is increased and provides relief in bronchial asthma.

NO is produced endogenously from the blood vessels and mucosa of the nose and paranasal sinuses. NO is naturally produced in youth and goes down with aging, mainly hampering the blood circulation to ear, brain, heart, and sex organs.

Humming increases the production of NO from sinuses and nasal mucosa. Eby explained humming as a sonic cleanser, cures the infection of sinuses. NO by decreasing the swelling of sinus ostia results into better drainage and oxygenation.[6] Humming exercise also increases the vital capacity. It is estimated that humming increases the endogenous generation of NO level by 15-fold as compared with the quite exhalation.[7] Because of its vasodilator effect, NO can control the filling of nasal capacitance vessels, thus nasal airflow, nasal mucosal temperature, and humidification, hence providing air conditioning to sinuses and respiratory passage. This, in turn, affects the ciliary flow and cleansing of the nose, paranasal sinuses, including nasopharyngeal tubes. Better air flow and ciliary clearances of nasopharyngeal tubes influence the ventilation and impedance of the middle ear resulting in an improvement in the quality of hearing. The NO generated during humming, by improving the Eustachian tube function and ventilation of cochlea through the round window affects the cochlear physiology, neurotransmission, and regulation of cochlear blood flow.[8] It has been observed that adding a small amount of NO to the oxygen to the premature infants prevents blindness, cerebral palsy, and deafness.[9]

NO released by Bhramari accelerates the microcirculation of blood and Bhramari by vibration, declogs the tiny blood vessels of the brain and inner ear.

 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 sound (ultrasound therapy) is a known modality in the treatment of tinnitus and sensorineural deafness. Apart from the restoration of hearing by stimulating the hair cells and generating action potential, Bhramari Pranayama is also quite effective in de-stressing.

The exercise can be performed sitting comfortably in calm place, eyes closed, relaxed mood with a smile on face, place your index finger gently in the ear canal or on tragal cartilage to gently block the ear canal. Take a deep breath and as you exhale slowly, make a loud continuous sustained pitch humming sound and generate an echo, focus your attention toward the inner ears. A high pitch sound gives better results. It also helps in regaining better speech recognition. It is an exercise of Hatha Yoga you have to imagine and give command through the brain that there is an increased circulation of oxygen and blood to the inner ear and your hearing is improving with every breath and echo of sound.[10]

Shanmukhi Mudra is a modification of Bhramari Pranayama for better and earlier improvement. The procedure is place your both thumbs at the inlet of external auditory canal, both hands' index fingers on the forehead just above the eyebrows at the level of Agya Chakra (solar plexus) middle fingers on the medial canthus of eyes, ring fingers on the ala of nose do not pinch or block the nasal airway, and little fingers on upper lip. Take a deep breath close your mouth with ballooning of cheek and tuck your chin into the chest, a high pitch continuous sustained humming sound is produced https://youtu.be/9rOnhM_WO6s.[11]

Diet influences your body, mind, and soul, hence you are what you eat, drink, and do (yoga).[5] Your life style changes, diet, correction of Vitamin D deficiency [12],[13] and yoga help you fight with disease. In diet, beetroot, spinach, lettuce, Chinese cabbage, radish, mustard leaf, carrots, and green beans are the sources for providing semi-essential amino acids which are precursor for the production of NO in the body. The production of NO is influenced and enhanced by exercise and humming sound.

Nitrite is converted into NO by the macrophages and endothelium of respiratory mucosa including mucosa of the nose and paranasal sinuses, which in turn dilates the vessel. The endothelium releases more NO on physical activity and in low cholesterol level. Stress reduces the release of NO. Horror movies reduce NO level, whereas comedy movies increase NO level.

Apart from calming the brain by improving the quality of sleep, NO helps memory and behavior by transmitting information between neurogenic cells in the brain, NO may increase the recognition of sense that is speech discrimination and improves the quality of hearing which goes down with the age.

Greeva Chalan (Cervical exercise) releases the muscular spasm, stiffness, and fixation of cervical spine bones leading to increase blood supply to the brain and inner ear; hence, cortical brain functioning will be better and improving the grasping power and speech discrimination. Skandh Chalan (Shoulder exercise) helps in overcoming upper girdle weakness and depression.

 Materials and Methods



In July 2015, publicity was done to make the public aware that institution is organizing a free deafness detection camp. Camp was attended by 72 patients of deafness. All the patients were screened thoroughly complete ENT examination; detailed history of deafness, tinnitus, and systemic disorders was taken. Blood pressure and blood sugar evaluation of all patients apart from pure tone audiometry and tympanometry were done.

A total of 15 middle-aged and senior citizens who did not benefit with the hearing aid were scrutinized who were having predominately sensorineural deafness, which were the subject for the present study.

The selection criteria

Sensorineural deafnessWilling to undergo yoga and follow-up yoga regularly for 3 monthsResiding in the vicinity of 3.0 km area of the hospitalNot benefited with hearing aid.

Exclusion criteria

A clinical ear discharge or other systemic diseaseCoronary heart disease.

Out of 15 patients, 2 patients lost follow-up in yoga after 2 months hence not included in the study.

 Results



Totally 13 patients were evaluated after 3 months of regular follow-up and practice maximum number of patients were between 55 and 60 years age group, that is, 6 (46.1%)[Table 1].{Table 1}

All patients had sensorineural deafness only two patients had tinnitus and three patients had increased blood sugar (known diabetic).

All patients were evaluated after 3 months, two patients were satisfied whereas 11 patients had improvement of average 9 dB, two patients did not show improvement, out of which one was diabetic. Out of three known diabetic, one improved and blood sugar level came down to near normal limits. And also patient had hearing improvement [Table 2].{Table 2}

Two patients were of cervical spondylitis both improved. Out of 13 patients, 12 patients had overall betterment in the quality of life, one patient female 65 years who was not having any improvement in hearing, good yoga performer; although, audiometry showed 15 dB improvement, subjectively no improvement, she was enthusiastic to continue yoga.

All the five patients having a history of forgetfulness were subjectively better.

Snoring was notified in nine patients recovered significantly in all patients. One patient who had symptoms of benign prostate enlargement and increased prostate-specific antigen (PSA) claimed he is better and PSA came down.

 Discussion



No authentic published data could be searched of the Indian subcontinent to compare this preliminary pilot project. The study was conducted to evaluate the importance of yoga, lifestyle changes, diet modification and avoiding ototoxic drugs and chemicals in cases of sensorineural deafness. As discussed in material methods, the technique of yoga was collaborated with emphasis on breathing technique during cervical and shoulder exercise done to increase the vital capacity and better lung functioning.

 Conclusion



The preliminary pilot study shows that there is an improvement in hearing after 3 months in 11 (84.6%) and improvement in the quality of life 12 (92.3%). There was also improvement and control in diabetes or prostate symptoms. A preliminary study showing promising results and prompts further study which has been already initiated and we expect promising result in next few months.

References

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2WHO. Global Estimates on Prevalence of Hearing Loss; 2012. Available from: http://www.who.int/pbd/deafness/WHO_GE_HL_pdf.
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6Harada N. Role of nitric oxide on purinergic signalling in the cochlea. Purinergic Signal 2010;6:211-20.
7Eby GA. Strong humming for one hour daily to terminate chronic rhinosinusitis in four days: A case report and hypothesis for action by stimulation of endogenous nasal nitric oxide production. Med Hypotheses 2006;66:851-4.
8Muñoz DJ, Thorne PR, Housley GD, Billett TE. Adenosine 5'-triphosphate (ATP) concentrations in the endolymph and perilymph of the guinea-pig cochlea. Hear Res 1995;90:119-25.
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10Taneja MK. Nitric oxide Bhramari Pranayam and deafness. Indian J Otol 2016;22:1-3. Available from: https://www.youtu.be/9rOnhM_WO6s.
11Taneja MK. Improving hearing performance through yoga. J Yoga Phys Ther 2015;5:194.
12Taneja MK. Role of Vitamin D in prevention of deafness. Indian J Otol 2012;18:55-7.
13Taneja MK, Taneja V. Vitamin D deficiency in E.N.T. Patients. Indian J Otolaryngol Head Neck Surg 2013;65:57-60.