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Year : 2021  |  Volume : 27  |  Issue : 3  |  Page : 121-123


Editor in Chief – Indian Journal of Otology

Date of Submission22-Nov-2021
Date of Decision07-Dec-2021
Date of Acceptance23-Nov-2021
Date of Web Publication16-Dec-2021

Correspondence Address:
Dr. Mahendra Kumar Taneja
Director - Indian Institute of Ear Diseases, 281, Civil Lines North, Railway Road, Muzaffarnagar 251001, Uttar Pradesh

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.indianjotol_165_21

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Presbycusis is aging deafness, progressive decrease in hearing, high frequency usually associated with tinnitus. This is due to the release of free radicals in cellular metabolism leading to cell death of cochlear hair cells, stria vascularis, and sensorineural degeneration. It also leads to vasoconstriction of end arteries resulting in hypoxia, ischemia, and necrosis of cells. Apart from hair cells, rest all can be regenerated by suitable environment, diet positivity, lifestyle changes, and proper diet along with Yoga and Pranayama. It is a long-run exercise. Since visual integration is a part of hearing, focused concentration, dynamic neurobics, and mid-brain activation also help in rehabilitation. The most important Pranayama is modified Nadi Shodhan (Kumbhak).

Keywords: Aging, apoptosis, deafness, modified Nadi Shodhan pranayama, Nasagra Mudra, old age, reactive oxygen species

How to cite this article:
Taneja MK. Presbycusis. Indian J Otol 2021;27:121-3

How to cite this URL:
Taneja MK. Presbycusis. Indian J Otol [serial online] 2021 [cited 2022 May 23];27:121-3. Available from: https://www.indianjotol.org/text.asp?2021/27/3/121/332646

  Introduction Top

Population of senior citizens is gradually increasing so is the life span. A person of 60 plus can expect another 20 years of enhanced life and active working. There will be around 200 billion senior citizens by 2050, and almost 30% will be having disabling hearing loss, which is 30db or more in the better ear.[1] WHO reports the incidence of deafness will go high and expects one in ten persons that is 10% population will be having hearing loss. Most of them will be deprived of working or getting a job; if yes, it will be in a lower grade of employment.[2]

It has been widely reported hearing impairment leads to isolation and depression and is one of the etiological factors for dementia and Alzheimer's disease. It is to be known that the brain of an elderly person is much more pliable/plastic than the young. The interaction between the two cerebral hemispheres becomes harmonious. The aged brain wins by flexibility and by both brain hemispheres working together from the youth. Intellectual abilities grow and increase with age and obtain a peak at the age of 80–90 years.

Awareness and prevention of aging hearing loss are scarcely discussed. I will be discussing the etiology.

  Prevention and its Management Top

Aging deafness is termed as presbycusis characterized by a progressive decrease in hearing sensitivity, reduced speech recognition, and decreased processing of acoustic impulses, speech discrimination is poor in a noisy surrounding. The deafness is usually in high frequency, bilateral, and may be associated with tinnitus.

By functional magnetic resonance imaging (fMRI), it has been observed that visual stimuli also stimulate the cortical auditory area.[3] By practice, we can stimulate and augment hearing by learning lip-reading, activation of nondominant brain, and mid-brain activation.[4] The speed of sound is 343 m/s, while the speed of light is 299, 792, and 458 m/s; hence, visual stimuli sensitize the cortical auditory area 874,000 times faster and earlier and works by audiovisual integration.[5] The core area of visual speech perception is the facial fusiform area in the right lateral portion of the fusiform gyrus, occipital face area, and posterior superior temporal sulcus[6] and has been confirmed by fMRI.

Before we proceed to prevention and rehabilitation, we must understand the etiology of aging deafness. Death of hair cells in cochlea is by apoptosis which is a genetically controlled mechanism initiated by loss of growth factor, radiation, especially mobile phone, WIFI, etc., and mainly by low intracellular oxygen level (hypoxia), leading to mitochondrial DNA damage resulting in damage and death of hair cells of the cochlea. This apoptosis is by an accumulation of reactive oxygen species (ROS).

This leads to oxidative damage. These ROS are molecules with one or more unpaired electrons. During energy production in cells, mitochondria by glucose and oxygen produce 38 units of ATP. Free radicals (ROS) arise as a by-product of the metabolic process. The production of ROS increases with age, stress, poor lifestyle, intoxication, rapid shallow breathing, noise, and radiation. These free radicals affect the mitochondrial DNA, specifically the cell death of hair cells, stria vascularis, and sensory neural degeneration. These free radicals (ROS) also lead to vasoconstriction of end arteries resulting in hypoxia, ischemia, infarction, and necrosis of cells. Today by videocapillaroscopic examination, we can confirm that ischemia is the root cause of sudden sensorineural hearing loss.[7]

Noise leads to the large displacement of the tympanic membrane and insult to the inner ear. The ROS released from this shearing force leads to upregulation of P53 in cochlea hair cells and cell death; hence, I can summarize the etiology of age-related hearing loss, poor  Eustachian tube More Details dysfunction, atrophy of stria vascularis, degeneration of spiral neural cells, atrophy and demyelination of auditory nerve, atrophy of cerebral cortex, and decreased number of functional hair cells of the cochlea. Only hair cells cannot be regenerated. Although it is a long exhaustive exercise, rest all can be regenerated. We must remember that neurons and the body can repair, regenerate up to the age of 90 years. It needs growth hormone by suitable environment, positivity, lifestyle changes, proper diet, and some exercise (Yoga Pranayama). The basic of hearing is not just perceiving the sound. It is by cognition, memory attention, neural processing, and speed of processing of hearing input. This part can be improved by focused concentration, dynamic neurobics, optimizing the cochlear and cerebral blood flow by modified cervical, Shoulder, Pag sanchalan exercises, Hastpad aasan, modified Bhramari Pranayama and mindful relaxation, and modified Kumbhak.[8]

  Kumbhak (Nadi Shodhan) Top

Kumbhak is a respiratory exercise that acts like carbogen therapy which can be justified scientifically as increased carbon dioxide level leads to dilatation of the tiny blood vessels, increases their permeability, and increases malleability of red blood cells (Bohr effect). This leads to better oxygenation and better nutrient supply to each cell of the body. It also increases nitric oxide levels in the body, which further potentiates these actions. In Bahya Kumbhak, holding the breath out, we exhale the air from the lungs for the maximum duration and capacity, hence increasing the blood CO2 level, which leads to stimulation and regeneration of higher centers, including the limbic system, hearing area, and parasympathetic nervous system (Ida Nadi).[9],[10]


To perform this exercise sit comfortably in Sukhasana or on a chair with a straight trunk and spine, left hand will rest on the left knee in Shunya Mudra, and the right hand is used for closing and opening of the nostrils, index and middle fingers are closed, and thumb on right ala of nose and right ring fingertip on left ala of the nose (Nasagra Mudra). Nasagra Mudra is symbolic of lord Ganesh and said to activate the Mooladhara Chakra, providing vitality and a good physique. The exercise starts with slow, gradual deep abdominal inhalation to the maximum from the left nostril with counting the digits 1–10 (duration 1 unit) filling the lungs entirely. The breath is kept on hold by closing both nostrils and counting 11–50 (duration 4 units) followed by slow forceful complete exhalation from the right nostril by squeezing the abdominal muscles counting 51–70 (2 units). For exhalation from the right nostril, the thumb will be withdrawn, and the left nostril will be closed by the right ring finger. Now both nostrils are closed again for 20 counts from 71 to 90 (2 units). One cycle is complete in 9 units (1:4:2:2): inhalation (one unit), breath holding in (4 units), exhalation (2 units), and breath holding out (2 units). Time of unit exercise (count ten) can be modified from six to sixteen counts as per body strength. For better and higher benefit, eyes are focused in Nasagra Drishti on the tip of the nose, while breathing in (poorak) perform silent chanting of “A” the first component of “Om.” On Antaha Kumbhak (holding breath in), silent chanting of 'O' the middle component of Om. During exhalation (Rechak). During exhalation, perform uninterrupted low pitch humming of 'Makar' the last component of OM, exhale only through the nose, keep mouth gently closed, jaw relaxed, lift up and invert the tongue backward and press on the hard palate (Khechri Mudar). Close both nostrils after exhalation for two units and give command of relaxation chant; my hearing is improving, I can listen better.

This is a powerful full exercise, increases vital capacity, regulates apoptosis, and increases blood supply by dilating the end arteries. This also optimizes blood pressure. For better parasympathetic stimulation (Ida Nadi), always press the tongue on the hard palate.

I conclude modified nadi shodhan Pranayama (Kumbhak) to be performed regularly for few months with patience and for early and better recovery modified cervical, Shoulder exercise, Hastpad Aasan, dynamic neurobics and Tratak should be performed along with Kumbhak.

Nutrition, supplementation with Vitamin D,[11] and avoiding ototoxic drugs, specifically mosquito coil, medicated toothpaste, chlorhexidine, is worth remembering. Petroleum/environmental pollution should be avoided as much as possible.[12] Now, intermittent fasting is getting recognized that is daily fast from 6:00 PM to 10:00 AM next day prevents and may reverse the atherosclerotic changes in blood vessels. To make the public and paramedics, a questionnaire can be circulated which provides awareness and knowledge of etiological factors.[13]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Taneja MK. Role of ENT surgeons in the national program for prevention and control of deafness. Indian J Otol 2012;18:119-21.  Back to cited text no. 1
  [Full text]  
World Health Organization Seventieth World Health Assembly Provisional Agenda Item 15.8, Prevention of Deafness and Hearing Loss. Report by Secretariat, A70/34; May 04, 2017. Available from: who.int/iris/bitstream/handle/10665/274920/A70_34-en.pdf?sequence=1&isAllowed=y.  Back to cited text no. 2
Rhone AE, Nourski KV, Oya H, Kawasaki H, Howard MA 3rd, McMurray B. Can you hear me yet? An intracranial investigation of speech and non-speech audiovisual interactions in human cortex. Lang Cogn Neurosci 2016;31:284-302.  Back to cited text no. 3
Taneja MK. Visual speech perception. Indian J Otol 2019;25:49-52.  Back to cited text no. 4
  [Full text]  
Taneja MK, Quereshi S. Holistic approach to deafness. Indian J Otol 2015;21:1-3.  Back to cited text no. 5
  [Full text]  
Fox CJ, Iaria G, Barton JJ. Defining the face processing network: Optimization of the functional localizer in fMRI. Hum Brain Mapp 2009;30:1637-51.  Back to cited text no. 6
Mom T, Montalban A, Khalil T, Gabrillargues J, Chazal J, Gilain L, et al. Vasospasm of labyrinthine artery in cerebellopontine angle surgery: Evidence brought by distortion-product otoacoustic emissions. Eur Arch Otorhinolaryngol 2014;271:2627-35.  Back to cited text no. 7
Taneja MK. Deafness, a social stigma: Physician perspective. Indian J Otolaryngol Head Neck Surg 2014;66:353-8.  Back to cited text no. 8
Taneja MK. Improving hearing performance through yoga. J Yoga Phys Ther 2015;3:194.  Back to cited text no. 9
Taneja MK. Prevention and rehabilitation of old age deafness. Indian J Otolaryngol Head Neck Surg 2020;72:524-31.  Back to cited text no. 10
Taneja MK, Taneja V. Role of vitamin D in prevention of deafness. Indian J Otol 2012;18:55-7.  Back to cited text no. 11
  [Full text]  
Taneja MK, Varshney H, Taneja V, Varshney J. Ototoxicity, drugs, chemicals, mobile phones and deafness. Indian J Otol 2015;21:161-4.  Back to cited text no. 12
  [Full text]  
Taneja MK. Public awareness and guidance of hearing care by questionnaire under “Shrawan Shakti Abhiyan”. Indian J Otol 2021;27: 51-5.  Back to cited text no. 13
  [Full text]  


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