Research and Reviews: Journal of Unani, Siddha and Homeopathy

ISSN: 2394-1960 (Online)

Volume 4, Issue 1
www.stmjournals.com

Description of Amraz-E-Gosh (Ear Diseases) in Unani and

Modern Perspective: A Review
Mohammad Aslam1,*, Basharat Rashid1, Zarnigar1, Malik Itrat1,
Mohd Akhtar Ali2, Md. Shahbaz Alam3
1
Department of Tahaffuzi Wa Samaji Tib (Preventive and Social Medicine), National Institute of
Unani Medicine, Kottigepalya, Bengaluru, Karnataka, India
2
Department of Ilmul Saidla (Unani Pharmacy), National Institute of Unani Medicine, Kottigepalya,
Bengaluru, Karnataka, India
3
Department of Ilmul Advia (Unani Pharmacology), National Institute of Unani Medicine,
Kottigeplya, Bengaluru, Karnataka, India

Abstract
The human ear is tremendously complex and amazingly designed organ meant primarily for
hearing and balancing the body. In Unani terminology, it is known as Uzuemudarikfaslat
(distance receptor organ). In classical Unani literature, diseases of the ear are well described
and are called as Amraze Gosh like Tarash (impaired hearing), Waqr and Samum (deafness),
Wajauluzn (ear ache), Tanin-o-Dawi (tinnitus), Siqle Samaat (reduced hearing), Hikkatuluzn
(itching in ear) Sansanahat (ringing of ears), Kaankephode (ear abscess) etc. The various
causes given by Unani scholars for the diseases of ear are Riyah, Imtila, Sue Mizaj, Zarb,
Zakhm, Deedan and Waram. They also propounded that the ear diseases may be congenital or
acquired, also it has been clearly mentioned that some of these ear diseases are more
prevalent in children. The preventive measures as mentioned by Unani scholars are numerous
viz.; avoid staying in Hawaebarid (cold air) for long time, excess of Aghzia-e mughalliza
should not be used, cleaning of the ear should be done properly, Roghanebadamtalkh should
be poured into the ear weekly, pin/stick should not be inserted in ear, ear should be protected
from Burudat (cold), Hararat (heat), strong wind, foreign bodies, entry of contaminated
water, genesis of Auram and Buthur in the ear should not be allowed, avoid sleep in condition
of Imtela-e shikam/tukhmah, etc.

Keywords: Amraze Gosh, ear diseases, Unani literature, preventive measures

*Author for Correspondence E-mail: aslambums@gmail.com

INTRODUCTION media (CSOM) is 4.8%. CSOM is estimated to

The human ear is tremendously complex and
wonderfully designed organ meant primarily for
hearing and balancing the body. According to
World Health Organization, 42 million people
(age>3 years) have hearing loss [1]. Prevalence
of hearing loss in South Asia in paediatric age
group is 2.4%. Overall prevalence of disabling
hearing loss in children all over the world is
1.7% [2]. WHO protocol estimated prevalence
of significant auditory impairment is reported to
be 6.3% in India [3]. Global incidence study
reported an acute otitis media incidence rate of
10.9%. Estimates suggest that 80% of children
will have at least one episode of acute otitis
media (AOM) before 3 years of age [4].
Further, global incidence of the most severe
form of otitis media, chronic suppurative otitis
contribute to more than half of the global
burden of hearing impairment. The burden and
population demographics of otitis media differ
greatly between developed and developing
regions. India and sub Saharan Africa (SSA)
account for most deaths from complications
arising from otitis media. Sub-Saharan Africa
(SSA) has the second-highest incidence of
CSOM [4].
Incidence of CSOM is higher in developing
countries because of poor socio-economic
standards, poor nutrition and lack of health
education. It affects both sexes and all age
groups [5]. The direness of CSOM is partly
attributable to its complications and the factors
influencing development of its complications

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Ear Diseases in Unani and Modern Perspective
are age, poor socio-economic group, virulence
of organisms, immune-compromised host,
preformed pathways, cholesteatoma, etc. [5].
In India, the overall prevalence rate is 46 and
16 persons per thousand in rural and urban
population, respectively [5].
Ear is also known as uzuemudarikfaslat
(distance receptor organ) [6]. Responding to
frequencies in the range of 20 to 20,000 Hz,
the ear, which helps human beings accomplish
a very important social function of
communication, is subject to a number of
ailments owing to its intricate structure and
majority of these ailments occur quite early in
life. Ear diseases are the common cause of
morbidity among children. The most common
ear problems are impacted wax, acute and
chronic suppurative otitis media and hearing
impairment, etc. [7].
All diseases and conditions of human ear are
divided according to the part involved
(external/middle/internal ear). The diseases of
external ear include diseases of pinna which
may be congenital, traumatic, inflammatory or
neoplastic. Similar categorisation of diseases
of the external auditory canal also is made. Of
relevant importance are inflammatory diseases
of the ear canal which are collectively termed
as the otitis externa and can be either of
bacterial, fungal or viral in origin.
Miscellaneous conditions like impacted wax,
foreign living or nonliving bodies owing to
poorly developed anatomical structures in the
paediatric age group are also frequently
encountered. The major bulk of the disorders
of the middle ear are formed by various kinds
of otitis media including ASOM, serous otitis
media, recurrent otitis media and CSOM.
Complications of both acute and chronic otitis
media, especially the latter may be as severe as
development of extra cranial conditions like
acute mastoiditis, masked (latent) mastoiditis,
labyrinthitis, petrositis, facial paralysis and
intra cranial complications like meningitis,
extradural abscess, subdural abscess, lateral
sinus thrombophlebitis, brain abscess and
otitic hydrocephalus [5]. The diseases of inner
ear are largely represented by Menieres
disease which is characterised by vertigo,
sensorineural hearing loss, tinnitus and aural
fullness [5].
RRJoUSH (2017) 31-38 STM Journals 2017. All Rights Reserved
Aslam et al.
The most common symptoms of ear diseases
are hearing loss, tinnitus, giddiness, delayed and
defective speech, earaches, vertigo etc. All
these symptoms affect an individuals
performance in various spheres of life.
Consequences of hearing impairment include
inability to interpret speech sounds, often
producing a reduced ability to communicate,
delay in language acquisition, economic and
educational disadvantage, social isolation and
stigmatisation [8]. Spoken language
development is often delayed in children with
deafness. Hearing loss and ear diseases can
have a significant adverse effect on the
academic performance of the children.
However if opportunities are provided for
people with hearing loss to communicate they
can participate on equal basis with others. In
developing countries, children with hearing loss
and deafness rarely receive any schooling.
Adults with hearing loss also have a much
higher unemployment rate. In addition to the
economic impact of hearing loss at individual
level, hearing loss substantially affects socio-
economic development in communities and
countries [9]. Whereas hearing loss seems to
influence the psychosocial and emotional
aspects more than the physical aspects, vertigo
has more impact on the physical aspect [10].
Tinnitus can affect individuals life, prevent their
intellectual work, disturb their daily routine and
have a general impact on their quality of life
[11]. Risk factors associated significantly with
COM/ROM include ethnicity, genetic factors,
gender, day-care center attendance, breast-
feeding, and allergy, etc. [12].
BRIEF ANATOMY OF THE EAR
The Outer Ear/Udhun Zahir
The outer ear also known as external ear [13
15], which is cartilaginous [14, 16], the
external auditory meatus (ear hole) and the ear
canal (external auditory canal) that leads to the
eardrum (or tympanic membrane) [1317].
Pinna
The pinna or auricle is also known as ghazruf
al-uzn or sadafmuwwiz (Ibn Sina), or
sadafnashirah (Abu Sahl Masihi) [6, 14, 18]
consists of auricular cartilage covered by skin
[6, 13, 15].
Ear Canal
The ear canal is 24 mm in length from outer
opening to the tympanic membrane [5, 15, 19,
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Research and Reviews: Journal of Unani, Siddha and Homeopathy
Volume 4, Issue 1
ISSN: 2394-1960 (Online)
20]. Although the shape of each ear canal
varies, in general the canal forms an elongated
"s" shape curve [6, 15, 21].
The ear canal maintains the proper conditions
of temperature and humidity necessary to
preserve the elasticity of the tympanic
membrane [17]. The skin of the cartilaginous
canal has sebaceous and ceruminous glands,
which produce cerumen (earwax) and hair
follicles in the ear canal provide added
protection against insects and foreign particles
from damaging the tympanic membrane
[13, 15, 17].
Middle Ear/Udhun Mutwassit
The middle ear is composed of the tympanic
membrane and the cavity, which houses the
ossicular chain [17].
Tympanic Membrane
The tympanic membrane or eardrum, also
known as ghisha tabali, serves as a divider
between the outer ear and the middle ear [5,
15, 18, 19]. It is greyish-white membrane, set
obliquely in the canal and it is convex towards
middle ear [15].
Middle Ear Cavity
The middle ear cavity is located in the mastoid
process of the temporal bone. The middle ear
cavity extends from the tympanic membrane to
the inner ear. The middle ear cavity is actually
an extension of the nasopharynx via the
eustachian tube [17].
Eustachian Tube
The eustachian tube acts as an air pressure
equalizer and ventilates the middle ear.
Normally the tube is closed [17], it opens
while swallowing [6, 20] and yawning [20]. It
connects the middle ear with pharynx [14, 20].
When the eustachian tube opens, the air
pressure between the outer and middle ear is
equalized [17].
Ossicular Chain
The middle ear is connected and transmits
sound to the inner ear via the ossicular chain.
The ossicular chain amplifies a signal
approximately 25 dB as it transfers signals
from the tympanic membrane to the inner ear
[5, 17]. The ossicular chain consists of the
three small bones in the middle ear; the
RRJoUSH (2017) 31-38 STM Journals 2017. All Rights Reserved
malleus, incus and stapes [5, 6, 17, 20]. The
malleus is attached to the upper half of the
tympanic membrane [19]. The footplate of the
stapes inserts into the oval window of the inner
ear. The incus is between the malleus and the
stapes [6, 17].
In Unani literature, the bones of ear are
described as mitraqi (malleus), sindani (incus),
rikabi (stapes) and the fourth one is known as
adasi (orbiculare) [14, 18].
The Internal Ear/Udhun Batin
The internal ear or labyrinth is an important
organ of hearing and balance [5]. It lies in the
petrous part of the temporal bone [19].
Functionally, the inner ear consists of two
major elements [21]: The cochlea also known
as qawqah or halzun [18], and the vestibular
system (comprising the utricle and saccule of
the vestibule, and the three semicircular
canals). The cochlea contains the organ of
hearing (organ of Corti) while the vestibular
system contains five balance organs: two
maculae (utricular macula and secular macula)
and three cristae ampullaris (one in each of the
three semicircular canals) [21].
Cochlea
The hearing part of the inner ear is the cochlea
also known as qawqah or halzun [6, 14, 18].
The cochlea is spiral shaped [17], and it
resembles to the shell of a common snail [14,
19]. It forms the anterior part of the labyrinth
and has a conical central axis known as
modiolus around which the cochlear canal
makes two and three quarter turns [19].
In classical Unani literature, diseases of the ear
are well described and are called as Amraze
Gosh like Tarash (impaired hearing), Waqr and
Samum (deafness), Wajauluzn (ear ache),
Tanin-o-Dawi (tinnitus), Siqle Samaat
(reduced hearing), Hikkatuluzn (itching in ear)
Sansanahat (ringing of ears), Kaankephode (ear
abscess), etc. [22]. The various causes given by
Unani scholars for the diseases of ear are Riyah,
Imtila, Sue Mizaj, Zarb, Zakhm, Deedan and
Waram [1]. They also propounded that the ear
diseases may be congenital or acquired [1, 22],
also it has been clearly mentioned that some of
these ear diseases are more prevalent in
children. The Unani scholars have mentioned
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Ear Diseases in Unani and Modern Perspective
the preventive measures of the ear
diseases/Amraz-e Gosh also.
COMMON PROBLEMS OF THE EAR
Earache/Wajaal-Udhun [2325]
The pain may be principally in the ear or may
be referred from other areas like the throat or
nose. Pain may be referred to the ear through
the 5th, 7th, 9th or 10th cranial nerves or the
cervical nerves (C2 and C3) [15, 26, 27].
In Unani literature, the causes of ear pain are:
cold and coryza, dental caries [24, 28, 29],
water in the ear, maggots of the ear, ulcers or
pustules in the ear [23, 28, 30, 31], cleaning of
ear with some sharp objects, joint pain [24,
28], Sue mizaj (altered temperament) [3234],
waram (swelling) [35, 36], reehbarid (cold air)
[3739], sudda (obstruction) [33, 36], akhlat
(humours) [33], burudat (cold), cold bathe
[40], and tafarruq-i-Ittisal etc. [34], impacted
wax; the condition is marked by redness of ear
and burning sensation with piercing pain [25].
Deafness/Hearing Impairment
If a child born with loss of power of hearing
(Quwwatesamiah) then he cannot talk because
when the child listens, then he talks, so the
power of hearing is important [23, 41]. The
term deafness may imply total or severe
hearing loss to a patient. The patient may
complain of hearing loss or reduction in
hearing which may be in one or both ears [15,
27]. Hard of hearing; a human being is said to
be hard of hearing if he/she has a hearing loss
which can be helped by medical/surgical
methods [15]. Hearing loss can be classified as
conductive deafness, sensorineural deafness
and mixed deafness. In Unani literature, the
causes of hearing impairment are Auram,
Buthur (pustules), Ghaleezakhlat (morbid
viscid humours), congenital, Waram
(swelling), Sudda (obstruction), Sue Mizaj
(altered temperament), Tafarruq-i-Ittisal
(discontinuity), tumours, foreign bodies etc.
[42], and hearing impairment is classified as
Waqr, Samam or Tarash.
Waqr (Deafness)
It is defined as complete loss of hearing.
Samam (Congenital Deafness)
An anomaly where patient has no external
auditory meatus [43].
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Aslam et al.
Tarash (Impaired Hearing)
It is defined as diminished power of hearing
[44]. It can be acquired, congenital, after acute
diseases, traumatic, senile, hot and cold
impaired temperament of ear, infiltration of
viscous humours in auditory nerve, obstruction
in the ear passage by ear polyp, foreign body
or tumours, akhlateghaleez (morbid viscid
humours), and wax etc.
Otorrhea (Ear Discharge)/Sayalanal-
Udhun
Discharge of fluid from the external auditory
meatus: The condition is common in children,
and persons with wet temperament [24, 41]. Its
causes are chronic catarrh, ulcer or swelling of
external auditory meatus, pustules of ear,
exposure to cold environment, foreign body,
acute infective diseases and teething period in
children etc. [25, 41]. Ear discharge may be
due to diseases of the ear, but it may be due to
other causes which are outside the ear. These
include fungal infection of the external ear like
otomycosis, bacterial infection of the external
ear like furunculosis, liquid wax, acute
suppurative otitis media (ASOM), chronic
suppurative otitis media (CSOM) and
suppurative labyrinthitis.
Causes outside the ear include; cerebrospinal
fluid otorrhoea due to road traffic accident,
perforation at the base of the skull, parotid
abscess, the abscess may track down via the
external ear canal [15, 27].
The discharge may be copious or very little,
constant or intermittent, serous or mucoid or
mucopurulent, foul smelling or odourless
[26, 27].
Tinnitus/Tanin-O-Dawi
This is ringing sound in the ear, or a condition
in which patient hears non-existing voices [45,
46]. It is very common and annoying
symptom. It may be mild and may occur only
at night; sometimes the tinnitus is constant and
loud and interferes with hearing [27]. When
the sound is of high pitch, it is known as Tanin
and when the sound is of low pitch, it is
known as Dawi [38, 47]. Tinnitus is one of the
most complicated symptoms to treat. It is due
to general weakness, under nourishment,
congestion of head with fluids and morbid
material, weakness of the hearing faculties,
presence of wax in the ear, ghaleezriyah,
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Research and Reviews: Journal of Unani, Siddha and Homeopathy
Volume 4, Issue 1
ISSN: 2394-1960 (Online)
diversion of waste material towards ear,
extreme dryness and hungriness, etc. [30].
Tinnitus can be classified as; subjective/Tanin-
e-zati which is experienced only by patient and
objective/Tanin-e-ghairzati which are audible
to both patient and examiner [45].
Causes of subjective tinnitus includes
impacted wax, perforation of tympanic
membrane, serous otitis media (causes
muffling of voice with low pitched tinnitus
and intermittent character), Otosclerosis (starts
with disease, ringing, roaring or whistling
sound continuous type, disappears as the
disease progresses), presbyacusis and acoustic
trauma produces high pitch tinnitus, ringing in
character, exposure to loud noise, Menieres
disease is categorized by low pitched
fluctuating tinnitus which becomes louder for
the duration of attacks and vestibular
schwannomacontinuous, high pitched. It may
be concluded that, any disease of the ear which
can cause deafness, may also create tinnitus.
Causes of Tinnitus
Ototoxic drugs causing high pitched tinnitus
are aspirin, quinine, salicylates, streptomycin,
dihydrostreptomycin, neomycin etc. Vascular
causes like atherosclerosis, hypertension etc.
can also cause high pitched tinnitus. Anaemia
and low blood pressure also cause low
intensity tinnitus [27]. Emotional factors may
cause tinnitus but tinnitus itself may initiate
anxiety and depression.
Causes of objective tinnitus include palatal
myoclonus, myoclonus of stapedius or tensor
tympani, vascular abnormalities, glomus
jugulare, aneurysms or AV fistulae, clicking
temporo-mandibular joints, intracranial vascular
tumours and live insect in the ear [26].
Itching in the Ear/Hikkaal-Udhun
Severe itching of the ear caused by
predominance of yellow bile, maggots, ulcers,
predominance of gases in the ear, insect bite,
pustules, wax, and diversion of saline fluids
towards ear etc. This may also be seen in patients
having otomycosis or some dermatological
conditions affecting the canal skin [29].
Swelling in Pre-auricular Area
Viral lymphadenopathy, the most common
swelling in this area, but mixed parotid
RRJoUSH (2017) 31-38 STM Journals 2017. All Rights Reserved
tumours or diseases of temporal mandibular
joint may present as swelling.
Swelling in Post-auricular Area
Most of the time it is subperiosteal mastoid
abscess, but tumours of muscles and bones
may be seen rarely [29]. In Unani literature,
the Waram (swelling) of post-auricular area
are described same as Auram (swelling) of the
other soft tissue of the body. These Waram
(swelling) are known as Baritoos or
Banatuludhun (daughter of the ear). These
Waram (swellings) may be Safrawi (bilious),
Balghami (phlegmatic), and Sawdawi
(melanotic). The disorder of the pinna may be
congenital, traumatic, inflammatory or
neoplastic [5, 15, 27].
Congenital Conditions of the Pinna
Some of the children born without external ear
opening and in some people, ear opening is closed
due to injury, tumour or burudat (cold) [48].
1. Anotia: Complete non-existence of pinna
and lobule.
2. Microtia: Small undeveloped pinna.
3. Bat ear: Abnormal protrusions of the
pinna.
4. Accessory auricle: Single or numerous
flesh or cartilage attachments may present
anterior to the pinna like a tag.
5. Pre-auricular sinus: An opening in the
anterior aspect of the auricle may
sometimes get infected and present as
painful swelling and may rupture and
discharge [27].
Traumatic Conditions of the Pinna
They may be haematoma of the auricle,
lacerations, avulsion of pinna, frostbite,
etc. [5].
In Unani literature, the avulsion of pinna is
known as Inqilaal-Udhun and it can be
defined as the detachment of the pinna by
severe pulling of ear or inflammation and
gases inside [39].
Inflammatory Conditions of the Pinna
They may be perichondritis, relapsing
polychondritis, etc. In Unani literature, the
inflammation of pinna may be due to
Waramhar (red type) and Warambarid (i.e.
soft and fluidly) [39].
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Ear Diseases in Unani and Modern Perspective
Wax/Wasakh al-udhun
In Unani literature, the impacted wax or
cerumen is known as Wasakh al-udhun and
defined as a condition where the wax in the ear
becomes viscous and hard thereby causing
hindrance in hearing. It is caused by improper
cleaning of ear, dirt, dust, cold and catarrh,
continuous irritation of the ear, use of sharp
corrosive ear drops and increased activity of
wax producing apparatus [24].
Foreign Bodies of Ear/Qadha fil udhun
The presence of foreign bodies in the ear is
common problem. Children may insert
different types of foreign bodies in the ear.
The foreign bodies of ear/Qadha fil udhun are
classified into living foreign bodies which
include insects (like, mosquitoes, cockroach,
ant, maggots etc.), and non-living foreign
bodies: They can be further classified into
vegetable and non-vegetable. Examples of
vegetable origin foreign bodies include: grains
[49], leaves, peas, seeds, etc. [48], while non-
vegetable origin foreign bodies includes; stone
[39, 49], pin, buttons, eraser, bead, etc. The
vegetable foreign bodies tend to engorge with
time and get firmly impacted in the auditory
canal.
PREVENTIVE MEASURES OF EAR
DISEASES
Ear diseases prevention, especially among
children is important to prevent hearing
impairment or even worse, deafness, age is a
risk factor for common ear infections, and
children bear the greatest risk due to their
generally weak immunity. Fortunately, we can
take various steps to prevent common ear
ailments in your family. Here are some
preventive measures for the prevention of ear
infections:
Practice good hygiene;
Eat healthy meals;
Proper breast feeding of infants;
Avoid secondary cigarette smoking fumes;
Get flu shots and vaccines; and
Avoid interaction with infected persons
[50].
The Unani scholars have mentioned the
preventive measures of the ear
diseases/Amraz-e Gosh. These are as follows:
RRJoUSH (2017) 31-38 STM Journals 2017. All Rights Reserved
Aslam et al.
Cleaning of the ear should be done.
Should not stay in hawae barid (cold air)
for long time.
More aghzia-e mughalliza should not be
used [31, 47].
Every week Roghan badam talkh should
be poured into the ear [28, 47].
Pin/stick should not be inserted in ear [36].
Ear should be protected from burudat,
hararat, strong wind, foreign bodies and
entry of contaminated water [31, 38].
Genesis of auram and buthur in the ear
should not be allowed.
Avoid sleep in condition of imtela-
eshikam/tukhmah [38, 47].
Cotton should be inserted in ear during
sleep.
More talking and listening of hard voice
should be avoided [28].
CONCLUSION
Diseases of ear are very well described in
classical Unani as well as in modern literature.
In Unani terminology, diseases of ear are
termed as Amraze Gosh and includes; Tarash
(impaired hearing), Waqr and Samum
(deafness), Wajauluzn (ear ache), Tanin-o-
Dawi(tinnitus), SiqleSamaat (reduced hearing),
Hikkatul uzn (itching in ear) Sansanahat
(ringing of ears), Kaan ke phode (ear abscess)
etc. In modern literature, the diseases described
are more or less same and are more commonly
found in the children up to 15 years of age.
Preventive measures are also very well
mentioned in both modern as well classical
literature and include good feeding practice of
infants, proper hygiene, protection of ear from
excessive heat or cold, prevention of foreign
body insertion, protection of children from
infected persons, etc.
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Cite this Article
Mohammad Aslam, Basharat Rashid,
Zarnigar et al. Description of Amraz-E-
Gosh (Ear Diseases) in Unani and
Modern Perspective: A Review.
Research and Reviews: A Journal of
Unani, Siddha and Homeopathy. 2017;
4(1): 3138p.
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