Sudden Hearing Loss Associated With Yoga Breathing Exercise

Bruce M. Gardner, MD

Disclosures

June 19, 2001

Question

A 45-year-old Indian woman presented with sudden deafness of the left ear one day after performing vigorous yoga breathing exercises -- specifically inhaling through one nostril and exhaling through the other. She had not done this particular exercise before. A day later she lost her hearing and experienced associated vertigo. Her physical exam was negative. The MRI was also normal, but an audiogram was abnormal. Blood results are pending.

What could be the etiology? Could this be caused by a hemorrhage in the inner ear?

Could you suggest any further evaluation?

Thiagarajah Sanmugam, MD

Response from Bruce M. Gardner, MD

The vigorous yoga exercise you describe, alternate-nostril breathing, is an ancient practice of aerating and energizing the tissues. It is for the purpose of inhaling prana, or life energy, and exhaling negative energies.[1] As with much of yogic practice, the concept of energy medicine does not always translate to Western medicine.

Done correctly, alternate-nostril breathing is safe and will not increase inner ear pressure. Initially the right hand is placed over the nose -- the thumb upon the right nostril, the third finger upon the left nostril, and the index finger resting on the bridge of the nose. With a slow, deep, and steady inhalation, and with the left nostril occluded, prana is inhaled deeply into all the tissues, visualizing energy flowing throughout the body. The left nostril is then released and the right nostril closed. A steady, slow, cleansing inhalation removes the old energy, "toxins," etc. The process is slowly repeated over and over, with each inhalation and exhalation rhythmic, steady, and full.[2]

Your patient may have tried to exhale with both nostrils occluded. The resulting increase in pressure most likely affected the middle ear. With symptoms of sudden loss of hearing and vertigo, one can infer damage to the oval window (fenestra vestibulus), the membrane connecting the middle and inner ear. The rapid movement of this membrane, moved medially by excessive force transmitted from the nasopharynx via the auditory (eustachian) tube, would cause turmoil in the perilymph (inner ear fluid). This turmoil would result in unwanted messages of movement, resulting in vertigo.

Such sudden percussive force also could create hearing loss. Swallowing, which closes off the nasopharynx, would have exacerbated the problem. If the percussive force created was vigorous enough, the stapes could have been irreversibly rent from its attachment to the oval window, or even fractured. If this occurred, the hearing loss would be permanent.

Further testing would include enhanced CT or MRI, with a specific focus on the cochlea and labyrinth. Hemorrhage in the middle ear would have been seen on physical examination; the MRI would be abnormal as well. In either case, an otorhinolaryngologist should be consulted immediately.

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