Indian Journal of Otology

EDITORIAL
Year
: 2018  |  Volume : 24  |  Issue : 4  |  Page : 209--213

Frequency-modulated Bhramari Pranayam in tinnitus and deafness


Mahendra Kumar Taneja 
 Indian Institute of Ear Diseases, New Delhi, India

Correspondence Address:
Mahendra Kumar Taneja
Indian Institute of Ear Diseases, New Delhi
India




How to cite this article:
Taneja MK. Frequency-modulated Bhramari Pranayam in tinnitus and deafness.Indian J Otol 2018;24:209-213


How to cite this URL:
Taneja MK. Frequency-modulated Bhramari Pranayam in tinnitus and deafness. Indian J Otol [serial online] 2018 [cited 2019 Apr 23 ];24:209-213
Available from: http://www.indianjotol.org/text.asp?2018/24/4/209/254223


Full Text



Tinnitus is a Latin word derived from tinnere which means ringing. It is characterized by perception of sound, buzzing, hissing, ringing, or roaring in the absence of any objective source of sound. Tinnitus is subjective when the person hears only but some time can be heard by the examiner termed as objective tinnitus. Most cases of objective tinnitus can be cured by medical or surgical treatment. The incidence vary from 10% to 26.7% in different groups and 50% of them are bothered and in 1%, it affects substantially to their life.[1]

The tinnitus may lead to considerable distress, agony, and mental symptoms. Most of the tinnitus are idiopathic where no cause can be find out. It is widely accepted that generation of tinnitus is central in origin that is from the hair cells of cochlea to cerebral cortex. Classically, tinnitus is mostly accompanied with hearing loss which is sensorineural in nature. The causative factor presumed as decreased blood supply leading to ischemia and damage to hair cells, auditory nerve, and auditory cerebral cortex. In the cerebral cortex, neuron changes their spontaneous activity and receptive field. It has been observed on positron emission tomography; there are changes in hippocampal area, limbic system, and frontal area in patients of tinnitus.

Magnetoencephalography demonstrates that auditory cortical map area corresponding to tinnitus frequency is distorted. The amount of distortion matches with the amplitude of tinnitus. Since there is no specific treatment, or modality for cure of tinnitus. A behavioral training may be a powerful mean to reverse maladaptive cortical reorganization.[2]

Frequency-specific sound therapy or music specifically raga-based music may lead to synaptic or cellular plasticity mechanism.

The tinnitus hearing impairment leading to forget fullness (dementia) affects the limbic system. It is the limbic system which affects the hormones and body function; hence, a vicious circle sets in. The tinnitus leads to stress and stress aggravates the tinnitus. The somatic tinnitus syndrome includes those forms of tinnitus that are associated with a somatic disorder involving the head and upper neck. It has been suggested that physiological mechanisms where interactions occur between the somatosensory and auditory systems are the etiology for that kind of tinnitus. Transelectrical nerve stimulation of areas of skin close to the ear increases the activation of the dorsal cochlear nucleus through the somatosensory pathway and may augment the inhibitory role of this nucleus on the central nervous system and thereby ameliorates tinnitus.[3] Hence, neck and shoulder exercises may diminish tinnitus.

The sound therapy is an established modality in tinnitus management. It addresses by toning the middle ear muscles, stimulating the hair cells, calming hyperactive neuron, and correcting auditory mapping. As you do physiotherapy for muscles and joints. Bhramari (Music) is a specific therapy for toning the auditory apparatus.

The variable frequency of chanting OM improves the responsiveness of stapedius muscle which also helps in regulating the pressure of inner ear preventing old age giddiness. The ear is connected to brain by seventh, eighth, ninth, and tenth cranial nerves. The most important nerve, vagus (parasympathetic nervous system) affects the heart and digestive system. Therefore, stimulating the vagus nerve, by sound at specific frequency, the ear and brain calm down including the entire body and nervous system.[4]

As a rehabilitative measure, tailor-made notched sound therapy specifically filtering the sound frequency matching to tinnitus on the principle of sound enrichment has been able to relieve the symptoms in most of the cases.[5] The duration of treatment may vary from days to months.

 Materials and Methods



The study was conducted at Indian Institute of Ear Diseases, Muzaffarnagar; a total of 128 patients were registered complaining of tinnitus. Eighty patients were selected for the study who were ready to undergo 3-month study. Patients were divided in two groups; one with placebo and other with placebo, along with yoga and meditation. All patients underwent Ear, Nose, and Throat examination.

There was general examination along with routine blood and urine examination. All patients were also evaluated by tinnitus handicap inventory and dementia assessment chart. All patients were evaluated on a monthly basis.

The selection criteria were (1) unilateral tinnitus, (2) whistle-like tinnitus, (3) tinnitus frequency lower than 8000 Hz, (4) hearing loss not severe, (5) no neurological or psychiatric problem, (6) no discharge or active ear disease, (7) no active cardiac disease, (8) inclined to yoga, (9) living in vicinity of institute, and (10) committed to attend regularly for 3 months.

Patient hearing assessment (audiometry) and tinnitus matching was done. Tinnitus frequency and amplitude was told to musician to analyze the octave (Saptak) of sound to be generated. The patients practiced 3 days Bhramari Pranayam (humming) initially under the supervision of musician, later under the guidance of yoga instructor. Modified Bhramari (frequency modulated) with specific technique 21 rounds, three times a day was practiced. Patients had also undergone cervical (neck) Greeva Chalan (three times), Skandh Chalan (ten times), Hasta padasana (three times), and Paschimouttan Aasan 5 min; all the above with deep inhalation and after breath holding.[6] Patients were advised to avoid caffeine, smoking, tobacco, and chewing chocolate including all ototoxic and stimulant drugs[7] (analgesics). Patients were advised raw chlorophyll-rich diet,[8] along with Vitamin D[9],[10] and calcium supplementation.

 Results



A total of eighty patients were the subject of the study; 40 in Group A and 40 in Group B were registered. All patients were evaluated 3 months after the regular follow-up. Group B underwent yoga and meditation; maximum number of patients were in 50–60 years group with overall average age (57) as shown in [Table 1].{Table 1}

The incidence of tinnitus was maximum in the age group of 55 to 65 years [Table 2]. The incidence of deafness was between 15 dB to 40 dB, but majority were in the range of 20–35 dB (Group B). The average hearing loss was 25 dB.{Table 2}

The associated systems are shown in [Table 3] along with improvement after 3-month yoga and meditation practice. Nine patients who had associated cervical spondylitis were symptomatically better including improvement in handwriting. Fifteen patients had a history of forgetfulness (dementia), their records were better on dementia chart. In nine patients who were diabetic, four responded well and their blood sugar level was in acceptable limits. In group B there was impact on quality of life in 30% and impairment in hearing in 55%, details shown in [Table 4]. The majority of patientswere having tinnitus in the range of 4000 Hz [Table 5].{Table 3}{Table 4}{Table 5}

Modified Bhramari

Patients were instructed to take a slow deep abdominal breath, lift the tongue and press on hard palate in Khechari Mudra, hold the breath, blow the cheek for better echo, close both ears with thumbs of both hands keeping them on concha simultaneously blocking the ear and tragus, and both eyes are gently closed by index finger. The index finger should rest on the lateral wall of nose. Both middle fingers are put on Ala of nose, and mouth is closed on both sides, upper lip by ring fingers and lower lip by little fingers. Both eyes are focused in Shambhavi Mudra at the Ajna Chakra in-between both eyebrows. A constant rhythmic-uninterrupted specific frequency sound (mouth closed) is generated. Spiritual concentration is focused on Dwarika Dhish (Deity). After complete exhalation, hold the breath out; Vahya Kumbhac is enforced with Jalandhar bandha and spiritual focus on Lord Shiva (Deity). Keep holding the breath out as long as possible, repeat the cycle 21 times.

Greeva Chalan (neck exercise)

With the growing age, there is some degree of reduced blood supply to brain and labyrinth by compression of the vertebral artery (VA) due to stiffness of neck muscles (cervical spondylosis). Compression of VA can be minimized by regular cervical (neck) exercise.

Body Position – The neck exercise can be performed sitting on chair, floor, or on bed margin. Fix the upper half of body by fixing the upper limbs including shoulder by placing both palms firmly on ground, arms of chair, or on thighs so that only neck and head should move, movement below the neck is not allowed.

It is a set of four exercises

Neck flexion-extension exercise

Start the exercise by slow deep abdominal breath through the nose and by holding the breath in. Tuck the chin into the chest by gently bringing the head downward.

Focus physical awareness on the back of the neck and spiritual awareness on Vishuddhi Chakra. Hold the breath in and position to the maximum duration; give the command that all neck muscle are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain, and now come in neutral position and exhale. Inhale deeply and slowly in abdomen. Gently band the head upward and backward, let it go to the maximum with ease. Focus your physical awareness on the back of neck muscles and spiritual awareness on Vishuddhi Chakra. Hold the breath in and position to the maximum duration; give the command that all neck muscles are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain, exhale and come into the neutral position. Repeat whole of the exercise three times.

Note – Relax by slow deep abdominal breathing, hold the breath, and there is no tension or stress. Give a command that you are feeling comfort and release of spasm of neck muscles with loosening of vertebral joints.

Patients of severe cervical spondylitis should start the exercise with extension only, once spasm is released, may go for flexion exercise.

Lateral flexion exercise

Start with the slow deep abdominal inhalation, hold the breath in, and fix the shoulders. Flex (tilt) the neck to the right, try to touch your right ear to right shoulder. Do not lift the shoulder, keep the palms firmly on floor, and be gentle but with definite stretching. Focus your physical awareness to the back of the neck and spiritual awareness to Vishuddhi Chakra. Hold the breath in and position to the maximum duration; give the command that all neck muscle are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain. Come in neutral position and exhale. Again take a slow deep abdominal breath than flex the neck to left and make effort to touch left ear to the left shoulder. Hold the breath in and position to the maximum duration; give the command that all neck muscle are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain, exhale, and come back into the neutral position. Do not turn or rotate your head.

Head rotation exercise

Start with slow deep, abdominal breathing, hold the breath, fix the shoulders, and rotate your head on neck to the right side. Focus your awareness to the back of neck and spiritual awareness to Vishuddhi Chakra. Be gentle but try to rotate and stretch to your maximum; hold the breath in and position to the maximum duration; give the command that all neck muscle are getting relaxed and there is no spasm and no pain; enjoy and feel the increase in blood flow to the ear and brain.

Now, come in neutral position and exhale. Again take a deep abdominal breath, rotate your neck to left gentle but with definite stretching. Focus your awareness to the back of neck and spiritual awareness to Vishuddhi Chakra. There is no pain, hold the breath in and position to the maximum duration, give the command all neck muscle are getting relaxed and there is no spasm and no pain, enjoy and increase blood flow to the ear and brain, and come into the neutral position.

All these three exercises are performed to the maximum stretch and maximum duration and movement, but with ease, no overstretching or pain; remember, all yogic exercises are for relaxation, so smile and enjoy them.

Second set of three exercises: Performed in the same way but we do not move the head but apply the counter pressure on head by the hand to stretching neck muscles.

360° head rotation

It should be performed by the beginners in sitting posture to avoid giddiness and sudden fall. After slow deep abdominal inhalation and holding the breath in, start by tucking the chin into the chest swinging to the left shoulder to back then going to the right side shoulder and coming back forward and downward in the initial position. Repeat 3 more times.

Again a slow deep abdominal inhalation with holding of breath in, repeat the exercise three more times starting by the rotating the head to the right side shoulder to back then going to the left side shoulder and coming back forward and downward in the initial position; perform at least three rotation in slow pace but keep holding the breath in and exhale. Now inhale deeply, slowly in abdomen, exhale fully by squeezing the abdominal muscles, and relax.

Skandh Chalan (shoulder exercise)

Sit comfortably on chair or hard comfortable floor preferably in Sukhasana, put both hands on both knees, elbows just touching to the sides of body. Start with slow deep abdominal inhalation and holding the breath in. Focus your physical awareness on back between the shoulder blades and spiritual awareness on Manipura Chakra. Rotate your both shoulders first forward then upward then backward and then downward completing one cycle.

Try to do it maximum time steadily in a single breath, repeat your breath if needed. Do it 21 times, relax, and give a command that all neck and shoulder muscles including the ear and brain are revitalized. Repeat the exercise in reverse direction.

Relax by slow deep abdominal breath, hold it, and give a command that every neck and shoulder muscles is relaxing, there is no spasm, and all muscles including ear and brain is revitalized. Repeat the shoulder exercise in reverse direction after holding a deep abdominal breath. Both shoulders should go down then posterior, superior and coming anterior and in the initial neutral position completing one cycle. Do it maximum time in a single breath, repeat your breath if needed. Do it 21 times, relax, and give a command that all neck and shoulder muscles including ear and brain are revitalized. Repeat the exercise in reverse direction.

Alternate shoulder rotation exercise

After deep inhalation and holding breath, exercise is performed; right shoulder goes up and left shoulder will go down and when right shoulder will go forward, the left will go backward, thus completing the cycle; do it maximum time in a single breath. Repeat your breath if needed. Do it 21 times, relax, and give a command that all neck and shoulder muscles including ear and brain are revitalized. Repeat the exercise in reverse direction.

Note – This exercise is a powerful exercise. It revitalizes the body, builds up confidence, alleviates depression, delays aging, and prevents from dementia and Alzheimer's disease.

Hasta padasana

Hast mean hand and Paad means foot; hence, a union of hand and foot is termed as hastapadasana.

Stand erect with both feet together, for senior citizen both legs 10 cm apart, hands by the side of the body, relax, and smile with maintaining weight equally on both legs. Join both hands by joining in pranam mudra at the level of lower chest (Anahata Chakra) and Chant “Om mitray Namay.” Take a slow deep abdominal breath, hold it, stretch your trunk shoulder, both arms upward, flex the head tuck the chin into the chest, bend forward so that the trunk becomes parallel to the floor, relax the shoulders and upper arms but arms stretched and elbow extended.

Exhale completely, squeeze your abdomen, bend further forward and downward on lower spine, do not bend your knees, and try to touch your fingers to the great toe. Practice it gradually; whole hand should touch the feet or the floor by the sides and forehead to the knees. Relax your body. Focus your spiritual awareness on Svadhisthana Chakra and physical awareness on lower back muscles. Hold the breath in and position to the maximum duration, give the command all back muscles are getting relaxed and there is no spasm and no pain, enjoy, and feel the increase blood flow to the ear and brain, slowly return to the neutral position in reverse order. Inhale and relax.

This aasana improves (Vata dosha) digestion, alleviates flatulence, increases blood flow to brain and hence improves concentration, improves hearing and speech discrimination, delays aging, and prevents dementia and Alzheimer's Disease.

Paschimoutan aasan

Sit on the floor with both legs out stretched knee, feet together, and toes pointed toward the sky. Take a long breath, hold it, squeeze the body, exhale, and relax the whole body.

Take a long deep abdominal breath, raise both hands, shoulder, chest, and complete upper half of the body (torso), exhale, and bend forward on lower spine; try to grasp the great toe with fingers and thumbs. Bend slowly without facing or jerking keep holding the breath out and body position, give a command to relax the back muscles and leg muscles allowing them to stretch, remember keep the legs stretched and knee fully extended; begin to bend the elbows and generally bend the trunk to touch the forehead to knees, relax in final position, and your physical awareness on the back of spine and spiritual awareness on Ajna Chakra, give a command that your whole body, ear, and brain is revitalizing, inhale, and return to the starting position and relax.

 Discussion



In continuation to our previous study, where we conducted a study of improvement in hearing at AYUSH Bhawan Delhi by Bhramari Pranayama which was encouraging, Tailor-made notched sound therapy and sound enrichment therapy are a known modality to treat idiopathic tinnitus. Modified Bhramari works in five ways (1) by conventional sound therapy, (2) by vibration declogging the tiny blood vessels, (3) stimulating the limbic system, vagus nerve, and pineal gland, (4) improving the neural plasticity along with calmness in the body, (5) sound enrichment therapy.

Bhramari is a humming sound; it increases the production of nitric oxide (NO) from sinuses and nasal mucosa.[11] Eby explained humming as a sonic cleanser, cures the infection of sinuses, and it is estimated that humming increases the endogenous generation of NO level by 15 fold as compared with the quite exhalation.[12] Because of its vasodilator effect, it affects the cochlear physiology, neurotransmission, and regulation of cochlear blood flow.[13] It has been observed that adding a small amount of NO to the oxygen to the premature infants prevents blindness, cerebral palsy, and deafness.

Bhramari in Shanmukhi and Khechari Mudra along with Shambhavi Drishti further potentiate the effects of neural plasticity and regeneration by acting on limbic system, hypothalamus, and pituitary gland through pineal gland.[14]

 Conclusion



Frequency-modulated (Sootkari) Bhramari Pranayama, with Nadi Shodhan (Vahya Kumbhaka) along with Greeva and Skandh Chalan gives encouraging results in patients of tinnitus deafness and early dementia.

If these can be made a part of lifestyle along with avoiding toxic food, ototoxic drugs, mobile phone, adding raw leafy green vegetables in diet, quality of life can be improved or sustained which goes down with stress and aging.

References

1Kochkin S, Tyler R, Born J. The Prevelence of Tinnitus in the united state and the self reported efficacy of various treatment. Hearing review. 2011;18:10-26.
2Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope 1999;109:1202-11.
3Herraiz C, Toledano A, Diges I. Trans-electrical nerve stimulation (TENS) for somatic tinnitus. Prog Brain Res 2007;166:389-94.
4Shim HJ, Kwak MY, An YH, Kim DH, Kim YJ, Kim HJ, et al. Feasibility and safety of transcutaneous vagus nerve stimulation paired with notched music therapy for the treatment of chronic tinnitus. J Audiol Otol 2015;19:159-67.
5Tyler R, Stocking C, Secor C, Slattery WH 3rd. Amplitude modulated S-tones can be superior to noise for tinnitus reduction. Am J Audiol 2014;23:303-8.
6Taneja MK, Quereshi S. Holistic approach to deafness. Indian J Otol 2015;21:1-3.
7Taneja MK, Varshney H, Taneja V, Varshney J. Ototoxicity, drugs, chemicals, mobile phones and deafness. Indian J Otol 2015;21:161-4.
8Taneja MK. Deafness, a social stigma: Physician perspective. Indian J Otolaryngol Head Neck Surg 2014;66:353-8.
9Taneja MK. Role of Vitamin D in prevention of deafness. Indian J Otol 2012;18:55-7.
10Taneja MK, Taneja V. Vitamin D deficiency in E.N.T. Patients. Indian J Otolaryngol Head Neck Surg 2013;65:57-60.
11Maniscalo M. Humming, nitric oxide and paranasal sinuses ventilation. Eur Respir J 2003;22:323-9.
12Eby 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.
13Taneja MK. Nitric oxide Bhramari Pranayam and deafness. Indian J Otol 2016;22:1-3.
14Taneja MK. Improving hearing performance through yoga. J Yoga Phys Ther 2015;5:194.