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| EDITORIAL |
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| Year : 2016 | Volume
: 22
| Issue : 1 | Page : 1-3 |
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Nitric oxide Bhramari Pranayam and deafness
MK Taneja
Senior ENT and Head Neck Surgeon, Indian Institute of Ear Diseases, New Delhi, India
| Date of Web Publication | 16-Feb-2016 |
Correspondence Address:
M K Taneja
Senior ENT and Head Neck Surgeon, Indian Institute of Ear Diseases, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-7749.176507
How to cite this article:
Taneja M K. Nitric oxide Bhramari Pranayam and deafness. Indian J Otol 2016;22:1-3 |
Nitric oxide is a gas molecule which has become an exceptionally important molecule in biophysics. It is a key biological messenger playing an important role in various biological processes at the cellular level. Nitric oxide is known as endothelium-derived relaxing factor and is biosynthesized endogenously from semi-essential amino acid, L-argenine, molecular oxygen, and various nitric oxide synthase enzymes.
Nitric oxide contributes to nonspecific host defense against bacterial, viral, fungal, parasitic infections, hence takes care of infection in the body. Nitric oxide improves ventilation–perfusion ratio in the lung along with relaxation of bronchial tree smooth muscles, hence oxygen uptake is increased and provides relief in bronchial asthma.
Nitric oxide is known to modulate nor epinephrine, serotonin, dopamine, glutamate, and the other major neurotransmitters involved in the neurological process. Nitric oxide plays a significant role in the inner ear to regulate the physiological reactions in cochlea. It also contributes to the basal discharge and response of afferent fibers. It is also established that a neurotransmitter or neuromodulator adenosine triphosphate (ATP) plays an important role in neurotransmission. Elevation of ATP concentration in the endolymph or perilymph by active noise trauma or hypoxia plays an important role in preventing cochlear damage.[1] Nitric oxide plays an important role at this level in functioning of inner ear physiology by regulating cochlear blood flow.[2]
Nitric oxide is produced endogenously from the blood vessels and mucosa of nose and paranasal sinuses. Nitric oxide is naturally produced in youth and goes down with aging, mainly hampering the blood circulation to ear, brain, heart, and sex organs.
Release of nitric oxide production is reduced in sinusitis. Chronic infection hampers the production and minimizes the action of nitric oxide.
Humming increases the production of nitric oxide from sinuses and nasal mucosa. Eby explained humming as a sonic cleanser, cures the infection of sinuses by decreasing the swelling of sinus ostea resulting into better drainage and oxygenation.[3] Humming exercise also increases the vital capacity. It is estimated that humming increases the endogenous generation of nitric oxide level by 15-fold as compared with the quite exhalation.[4] Due to its vasodilator effect, nitric oxide can control the filling of nasal capacitance vessels, thus nasal air flow, nasal mucosal temperature, and humidification, hence providing air conditioning to sinuses and respiratory passage. This in turn affects the ciliary flow and clinsing of 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 improvement in the quality of hearing. The nitric oxide generated during humming, by increasing the Eustachian tube function and ventilation of cochlea through the round window affects the cochlear physiology, neurotransmission and regulation of cochlear blood flow.[5] It has been observed that adding tiny amount of nitric oxide to the oxygen to the premature infants prevents blindness, cerebral palsy, and deafness.[6]
Sinuses are air-filled cavities and also act as a resonator; high volume, low pitch 130 Hz humming 60–120 times 4 times a day can clear the symptoms of chronic rhino sinusitis in 4 days' time.
Measuring nitric oxide is a simple procedure, easier then diabetes, strips are available, put a drop of saliva and instant results are available. Morning empty stomach sample is required; mouth wash and oral antibiotic are to be refrained in past 24 h which affect the accuracy of results.
Electromagnetic field (EMF) generated by Wi-Fi, cell phones, remote control devices, television, microwave ovens, and other radio devices can affect the individuals. The microwave pulse is absorbed by the soft tissue, launches thermoplastic waves of acoustic pressure reaching the inner ear via bone conduction, and stimulates the cochlear receptors. The response may vary in individuals, but EMF may lead/aggravate the tinnitus, hearing impairment, vertigo, Meniere's disease, acoustic neuroma apart from leading to irritability, epilepsy, and autism. EMF may also lead to DNA mutation and birth defects in a fetus if a pregnant woman is exposed. The WHO has also classified it as a possible cause of acoustic neuroma. Children are affected more with cell phone radiation.[7],[8]
With the increasing life span, we expect the prevalence of deafness as high as 40% above the age of 75 years.[9] The worst part of this deafness is it affects speech frequencies, hence only 20% can be benefited even with the best possible hearing aids.[10] 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%, decibel is an octave meaning 5 times.[10]
The workers of printing press, fuelling station (petrol pump), basic metal industries, chemical industries, pesticides, and lead industry are at 2-fold higher risk due to noise pollution and chemical toxicity, hence these workers should be made aware and prevented from this preventable hearing loss.
Noise, diabetes, cervical spondyliosis, hypertension, hypothyroidism, obesity, sinusitis, and eustachian tube 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.[11]
| Bhramari Pranayama (Bee Breath) | |  |
[12]
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 the treatment of tinnitus and sensorineural deafness. Apart from restoration of hearing by stimulating the hair cells and generating action potential, it is also quite effective in de-stressing. Bhramari releases nitric oxide in the body.
The exercise can be performed sitting comfortably in calm places, 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 humming sound and generate echo, and focus your attention toward the inner ears [Figure 1]. A high pitch sound gives better results. It also helps in regaining better speech recognition.
Shanmukhi Mudra is a modification of Bhramari Pranayama for better and earlier improvement. The procedure is place your both thumbs at tragal cartilage or at the 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. Take a deep breath and tuck your chin into the chest, close your mouth, with ballooning of cheek high pitch humming sound is produced [Figure 2] https://youtu.be/9rOnhM_WO6s.).
Diet influences your body, mind, and soul, hence you are what you eat, drink, and do (yoga). Your life style, diet, and yoga help you fight with disease. In diet, beet root, 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 nitric oxide in the body. The production of nitric oxide is influenced and enhanced by exercise and humming sound.
Nitrite is converted into nitric oxide by the macrophages and endothelium of respiratory mucosa including mucosa of nose and paranasal sinuses, which in turn dilates the vessel. The endothelium releases more nitric oxide on physical activity and in low cholesterol level. Stress reduces the release of nitric oxide. Horror movies reduce nitric oxide level whereas comedy movies increase nitric oxide level.
Nitric oxide helps memory and behavior by transmitting information between neurogenic cells in the brain, apart from calming the brain by improving the quality of sleep. Nitric oxide may increase the recognition of sense that is speech discrimination improves the quality of hearing which goes down with the age.
I conclude the correction of Vitamin D deficiency,[13],[14] avoiding exposure to ototoxic chemicals, minimum use of ototoxic drugs, and electromagnetic radiation prevent or delay aging hearing loss. Bhramari Pranayam, releases nitric oxide and when combined with Kumbhak, Greeva Chalan along with modification of diet and life style can prevent or delay the aging hearing loss. It potentiates immunity and senile degeneration (dementia Alzheimer's) including old age deafness.
Declaration of participant consent
The authors certify that they have obtained all appropriate participant consent forms. In the form the participant(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The participants understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
| References | | |
| 1. | Muñoz 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.  |
| 2. | Brechtelsbauer PB, Nuttall AL, Miller JM. Basal nitric oxide production in regulation of cochlear blood flow. Hear Res 1994;77:38-42. |
| 3. | Eby 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. |
| 4. | Maniscalo M. Humming, nitric oxide and paranasal sinuses ventilation. Eur Respir J 2003;22:323-9. |
| 5. | Fessenden JD, Schacht J. Localization of soluble guanylate cyclase activity in the guinea pig cochlea suggests involvement in regulation of blood flow and supporting cell physiology. J Histochem Cytochem 1997;45:1401-8. |
| 6. | |
| 7. | Taneja MK, Varshney H, Taneja V, Varshney J. Ototoxicity, drugs, chemicals, mobile phones and deafness. Indian J Otol 2015;21:161-4.  |
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| 9. | Taneja MK. Deafness, a social stigma: Physician perspective. Indian J Otolaryngol Head Neck Surg 2014;66:353-8. |
| 10. | Taneja MK, Quereshi S. Holistic approach to deafness. Indian J Otol 2015;21:1-3. |
| 11. | Taneja MK. Noise-induced hearing loss. Indian J Otol 2014;20:151-4. |
| 12. | |
| 13. | Taneja MK, Taneja V. Vitamin D deficiency in E.N.T. patients. Indian J Otolaryngol Head Neck Surg 2013;65:57-60. |
| 14. | Taneja MK. Role of Vitamin D in prevention of deafness. Indian J Otol 2012;18:55-7. |
[Figure 1], [Figure 2]
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