Medical Hypotheses (2006) 66, 851-854

medicalhypotheses

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Strong humming for one hour daily toterminate chronic rhinosinusitis in four days:A case report and hypothesis for actionby stimulation of endogenous nasal nitric oxideproduction

George A. Eby *

George Eby Research, 14909-C Fitzhugh Road, Austin, TX 78736, United States

Received 13 November 2005; accepted 17 November 2005

Summary Rhinosinusitis is an inflammation or infection of the nose and air pockets (sinuses) above, below andbetween the eyes which connect with the back of the nose through tiny openings (ostia). Rhinosinusitis can becaused by bacteria, viruses, fungi (molds) and possibly by allergies. Chronic rhinosinusitis (CRS) is an immunedisorder caused by fungi. The immune response produced by eosinophils causes the fungi to be attacked, which leadsto damage of the sinus membranes, resulting in full-blown rhinosinusitis symptoms. Gaseous nitric oxide (NO) isnaturally released in the human respiratory tract. The major part of NO found in exhaled air originates in the nasalairways, although significant production of NO also takes place in the paranasal sinuses. Proper ventilation isessential for maintenance of sinus integrity, and blockage of the ostium is a central event in pathogenesis ofsinusitis. Concentrations of NO in the healthy sinuses are high. Nasal NO is known to be increased 15- to 20-fold byhumming compared with quiet exhalation. NO is known to be broadly antifungal, antiviral and antibacterial. Thiscase report shows that a subject hummed strongly at a low pitch (~130 Hz) for 1 h (18 hums per minute) at bedtimethe first night, and hummed 60—120 times 4 times a day for the following 4 days as treatment for severe CRS. Thehumming technique was described as being one that maximally increased intranasal vibrations, but less than thatrequired to produce dizziness. The morning after the first 1-h humming session, the subject awoke with a clear noseand found himself breathing easily through his nose for the first time in over 1 month. During the following 4 days,CRS symptoms slightly reoccurred, but with much less intensity each day. By humming 60—120 times four times perday (with a session at bedtime), CRS symptoms were essentially eliminated in 4 days. Coincidentally, the subject'scardiac arrhythmias (PACs) were greatly lessened. It is hypothesized that strong, prolonged humming increasedendogenous nasal NO production, thus eliminating CRS by antifungal means.© 2005 Elsevier Ltd. All rights reserved.

Tel.: +1 5122630805.E-mail address: george.eby@coldcure.com.

0306-9877/S - see front matter © 2005 Elsevier Ltd. All rights reserved.doi:10.1016/j.mehy.2005.11.035

852 Eby

Introduction

Rhinosinusitis is an inflammation or infection of thenose and air pockets (sinuses) above, below and be-tween the eyes which connect with the back of thenose through tiny openings (ostia). Rhinosinusitiscan be caused by bacteria, viruses, fungi and possi-bly by allergies, inducing secretion of mucus fromgoblet cells, which is condensed. Upon secretion,mucus expands in volume tremendously and almostinstantaneously 500-fold during a period of only20 ms [1]. Proper ventilation is essential for main-tenance of sinus integrity, and blockage of the os-tium is a central event in pathogenesis of sinusitis.Acute rhinosinusitis last 7-10 days and often re-sponds to antibiotics.

About 37 million Americans have chronic rhinos-inusitis, with most lasting longer than a month, andwith some cases lasting a year or longer. Chronicrhinosinusitis (CRS) is the chronic human diseasethat is most frequently refractory to treatment.CRS is an immune disorder caused by fungi forwhich there is no FDA-approved therapy. The im-mune response, caused by eosinophils, results inthe fungi being attacked, which leads to damageof the nose and sinus membranes, resulting infull-blown, CRS goblet cell-activated symptoms.There may be only be a single symptom, such as apost-nasal drainage, stuffiness, or pressure aroundthe nose, or there can also be a combination ofthe these symptoms associated with a runny nose,clear or colored mucus, a cough, a sore or irritatedthroat, pain in the teeth, headache, or fever. Addi-tional symptoms which sometimes can occur arehoarseness, a decreased sense of smell, and full-ness of the ears.

In this first case report, the subject, a 64 year-old, white male weighing 80 kg had severe rhinosi-nusitis with post-nasal drainage, pressure, severeheadache and a productive cough, requiring 24-hour-a-day management for 1 month. Loss of sleepdue to the severity and frequency of the symptomswas severe. Steroid shots, guaifenesin, aspirin, zincacetate lozenges (antirhinoviral and antiherpetic)[2], intranasal antihistamines, oral decongestantsand oral antibiotics were either marginally benefi-cial or ineffective.

Candida was the most common cultured fungi inthe lavaged specimens in CRS patients according toJiang et al. [3]. Coconut oil, a natural antiCand/daalbicans agent [4], was deeply instilled into thenose by the subject where it was temporarily ben-eficial in stopping mucous production and drainage,but recurrence of symptoms required repeatedtreatment each 4 h. Efficacy of coconut oil and

resistance to both an antibiotic and an antiviralfurther suggested a C. albicans rhinosinusitis infec-tion, especially since it was known that the subjecthad a severe allergic hypersensitivity to it.

A more effective, more natural, longer lastingantifungal agent was needed. Nitric oxide (NO) isknown to be broadly antifungal, antibacterial andantiviral. For example, potent antiC. albicansactivity was observed by Ghaffari et al. [5] at200 ppm gaseous NO, killing 100% of these fungiwithin 4 h contact time, and 90% within 2 h.

Gaseous NO is naturally released in the humanrespiratory tract. The major part of NO found in ex-haled air originates in the nasal airways, althoughsignificant production of NO also takes place in par-anasal sinuses. Sinuses communicate with the nasalcavity through ostia, and gas exchange betweenthese cavities is dependent largely on the size ofthe ostia. The concentrations of NO in healthy si-nuses are high, sometimes more than 20 ppm. Na-sal nitric oxide is known to be increased 15- to20-fold by humming compared with quiet exhala-tion according to Weitzberg and Lundberg [6].According to Maniscalco et al., low frequency(~130 Hz) humming produces the greatest amountof NO [7].

Because nasal NO production by humming wasmeasured in exhaled air and not in nasal tissues,and even though Maniscalco et al. [7] reported thatrepeated humming reduced gaseous NO concentra-tion, it was decided to test strong, repeated hum-ming in the hope that NO concentrations in nasaland sinus linings, but not necessarily in exhaledair, would be increased to a concentration suffi-cient to treat CRS effectively. It was hypothesizedthat humming would produce sufficient nasal tissueNO to kill fungi locally and effectively treat chronicrhinosinusitis without being harmful.

After explaining the possible role of nasal NO intreating CRS possibly by antifungal means, theapparent lack of toxicity, and getting informedconsent, the subject proceeded to "hum" hisway to rhinosinus health.

Methods and procedures

The subject hummed strongly for 1 h (18 hums perminute) at bedtime the first night, and hummedstrongly at a low pitch (~130 Hz) 60-120 times infour sessions per day for the following 4 days. Thehumming technique was described as being onethat maximally increased intranasal vibrations,but less than that required to produce severe dizzi-ness. Inhaling through the nose between humming

Strong humming for one hour daily to terminate chronic rhinosinusitis in four days 853

efforts was viewed as an important feature to gainmaximum respiratory benefit from NO produced byhumming.

Results

The morning after the first 1-h humming session,the subject awoke with a clear nose and found him-self breathing easily through his nose for the firsttime in over 1 month. During the following 4 days,minor rhinosinusitis symptoms reoccurred, but withmuch less intensity each day. By humming 60-120times four times per day (with a session at bed-time) all rhinosinusitis symptoms were essentiallyeliminated within 4 days. Occasional one to tenminute humming sessions as needed afterwardmaintained sinus health.

Even though he slept soundly the first night, na-sal inhalations between humming efforts were notpossible due to severe nasal congestion, conse-quently mouth breathing was required at the begin-ning of sleep. All following inhalations betweenhumming efforts were conducted through the nosesince the nose remained essentially clear.

The only side effect noted was dizziness uponexcessively strong humming, which was preventedby slightly reducing the frequency and strength ofhumming.

Discussion

This research was stimulated by the comment thatthe concentrations of NO in healthy sinuses arevery high, sometimes more than "20 ppm" accord-ing to the online introduction of Weitzberg andLundberg [6]. However, this is a value vastly largerthan their actual observed data. The "20 ppm"comment coupled with their findings that nasalNO could be increased 15- to 20-fold raised hopesthat nasal nitric oxide could be increased to anti-fungal levels (200 ppm) or above. Although thereis an apparent 1000-fold discrepancy there, theseresults of efficacy in treating chronic sinusitis standas evidence that CRS can be effectively treated byrepeated, strong, low pitch (~130Hz) humming,apparently by NO generation.

Since 96% of all CRS is believed to be caused byfungus [8], and because NO is antifungal, especiallyto C. albicans, there is now hope that the hummingmethod will be highly effective in treating CRS bypatients with little or no other medical or surgicaltreatment required after diagnosis. Intranasalinstillation of antifungals, such as coconut oil [4]

or amphotericin B [9], with humming might in-crease efficacy.

The ability to strongly vibrate the nose by hum-ming may be diminished by small facial features,suggesting that small women and children mayneed to work harder than men in managing CRSwith humming.

Increased generation of nasal nitric oxide during. rhinovirus infections (common colds) is associatedwith fewer symptoms and more rapid viral clear-ance. Nitric oxide can inhibit human rhinovirus-in-duced epithelial expression of several pro-inflammatory cytokines and can inhibit viral repli-cation in epithelial cells in vitro [10]. Conse-quently, treatment of common colds using half anhour humming sessions each two wakeful hoursfor a few days may be beneficial.

Although nasal NO measurements in the treat-ment of allergy and asthma have been used to as-sess the severity of these illnesses, allergy andasthma might also be effectively treated by hum-ming. Humming for a few minutes as needed dailyseemed useful in this subject to manage his acutenasal allergy symptoms.

Another disease coincidentally responding tohumming in the same subject was cardiac arrhyth-mias (pre atrial contractions), which disappearedon the fourth day of humming. Prior to treatmentby humming, many fifth beats were abnormal,although taurine [11] had also been helpful in reg-ulating these beats. When PACs occur, this subjectnow converts them to normal with a 1-5 min hum-ming effort.

Reduced NO concentrations have been noted ina number of cardiac diseases, and treatment withNO has been shown to be beneficial. For example,Chen et al. [12] found in dogs that inhaled nitricoxide led to significant decreases in pulmonary vas-cular impedance. They also demonstrated effectsof inhaled nitric oxide in improving pulmonaryhemodynamics which were also associated withan increase in pulmonary blood flow, transpulmo-nary efficiency, and right ventricular contractilityin drug-induced pulmonary hypertension. Augment-ing endogenous NO may be of therapeutic benefitin humans as a means of favorably modifying thepattern of reduced parasympathetic and elevatedsympathetic cardiac tone that contributes to mor-tality in cardiac disease [13]. Nitric oxide (NO) isthought to reduce blood pressure by evoking vaso-dilatation either directly by causing relaxation ofvascular smooth muscle or indirectly by acting inthe brainstem to reduce central sympathetic out-flow, which decreases the release of norepineph-rine from sympathetic nerve terminals. Nitricoxide pathways are new drug targets for refractory

854 Eby

hypertension [14]. Also, NO may regulate exocyto-sis in a variety of physiological processes, includingvascular inflammation, neurotransmission, throm-bosis, and cytotoxic T lymphocyte cell killing[15]. Humming might find utility in treating andpreventing cardiovascular and other health issues,especially cardiac arrhythmias.

The idea of humming to treat and prevent rhinos-inusitis is reminiscent of yogis clearing their heads bychanting "Ommmm". Clearly, yogis are humming,and they may be "clearing their heads" by keepingnasal NO output high, thus clearing their sinuses.

The side effect of excessively strong and fre-quent humming, dizziness, precludes hummingfrom being used while driving a motor vehicle ordoing activities that requires full concentration.

In environmental studies, NO is considered anatmospheric pollutant, but research with elderlyasthma patients failed to demonstrate significantharm by NO even though exposure to elevatedatmospheric NO did increase exhaled NO [16]. Onthe other hand, nitric dioxide (N02) atmosphericpollution is well known to increase cardiovascularhospital admissions, mortality and life-threateningarrhythmias [17]. Nitrous oxide (N20) is also knownas laughing gas.

The hypothesis that strong low pitch (~130Hz)humming to greatly increase tissue nasal NO pro-duction as an effective means of treating CRSand, coincidentally, cardiac arrhythmias is sup-ported by these observations. Additional studiesare suggested and merited.

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