Description of amraz e gosh (ear diseases) in unani and modern perspective a review by MOHD AKHTAR ALI

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 Samaâ&#x20AC;&#x2122;at (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 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

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

Page 31

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 Meniere’s disease which is characterised by vertigo, sensorineural hearing loss, tinnitus and aural fullness [5].

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 individual’s 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 socioeconomic 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, breastfeeding, 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) [13–17]. Pinna The pinna or auricle is also known as ghazruf al-uzn or sadafmu’wwiz (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,

Page 32

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

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 qawq’ah 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 qawq’ah 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 Sama’at (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

Page 33

Ear Diseases in Unani and Modern Perspective

the preventive measures diseases/Amraz-e Gosh also.

the

Aslam et al.

ear

COMMON PROBLEMS OF THE EAR Earache/Waja’al-Udhun [23–25] 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) [32–34], waram (swelling) [35, 36], reehbarid (cold air) [37–39], 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].

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)/Sayalan’alUdhun 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,

Page 34

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/Tanine-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, Meniere’s disease is categorized by low pitched fluctuating tinnitus which becomes louder for the duration of attacks and vestibular schwannoma–continuous, 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/Hikka’al-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

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 Inqila’al-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].

Page 35

Ear Diseases in Unani and Modern Perspective

Aslam et al.

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 nonvegetable 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:

• • • •

• • •

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 imtelaeshikam/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-oDawi(tinnitus), SiqleSama’at (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.

REFERENCES 1. Maharjan M, Bhandari S, Singh I, et al. Prevalence of Otitis Media in School Going Children in Eastern Nepal. Kathmandu Univ Med J. 2006; 4(16): 479–482p. 2. Garg S, Gupta K, Anand T. Primary Ear Care in School Children. Sound Hearing 2030 (1st World Congress on Ear and Hearing Care); New Delhi. 2015; 39p. 3. Ansari MS, Ansari Hafiz MA, Bhimte SL. The Prevalence of Auditory Impairment

Page 36

Research and Reviews: Journal of Unani, Siddha and Homeopathy Volume 4, Issue 1 ISSN: 2394-1960 (Online)

6. 7.

8. 9.

10.

11.

12.

13.

14.

15.

and Speech Problems in Children with Developmental Disabilities (dd). Sound Hearing 2030 (1st World Congress on Ear and Hearing Care), New Delhi. 2015; 88p. Biagio L, Swanepoel DW, Laurent C, et al. Pediatric Otitis Media at a Primary Healthcare Clinic in South Africa. S Afr Med J. 2014; 104(6): 431–435p. Dhingra PL, Dhingra S. Disease of Ear, Nose and Throat. 6th Edn. Gurgaon: Elsevier; 2014; 2, 7, 21, 48, 51–57, 62–66, 68, 69, 72–76, 100, 101, 103, 106–108, 130p. Ahmad SI. Kulliyat Asri. New Delhi: New Public Press; 1983; 444–449p. Hatcher J, Smitha A, Mackenziea I, et al. A Prevalence Study of Ear Problems in School Children in Kiambu District, Kenya, May 1992. Int J Paediatr Otorhinolaryngol. 1995; 33(3): 197–205p. Mathers C, Smith A, Concha M. Global Burden of Diseases. 2000; WHO: 1. Anonymous. [Internet]. [Cited-2016-0415]. Available from: http://www.who.int/ mediacentre/factsheets/fs300/en/. Saoo AK, Preetam C, Samal D, et al. Rehabilitation of Hearing in Case of Bilateral Meniere’s Disease of the Young. Sound Hearing 2030 (1st World Congress on Ear and Hearing Care), New Delhi. 2015; 95p. Manathunga D, Fonseka R, Siriwardena C. Different Severity Levels of Tinnitus and How it Affects the Lifestyle of Patients who are Attending the ENT Clinics. National Hospital, Colombo. Sound Hearing 2030 (1st World Congress on Ear and Hearing Care). New Delhi. 2015; 97p. Zhang Y, Xu M, Zhang J, et al. Risk Factors for Chronic and Recurrent Otitis Media: A Meta Analysis. Pub Med Centre (NCBI). 2014; 9(1): 1/12–7/12p. Irwin J. Basic anatomy and physiology of the ear. In: Valerie E. Newton, Pamela J. Vallely (eds). Infection and Hearing Impairment. New York: John Wiley & Sons, 2006. Kabeeruddin M. Ifada-i-Kabir. New Delhi: Qaumi Council Bra-i Frogh Urdu Zaban; 2001; 236, 238–241p. Maqbool M, Maqbool S. Textbook of Ear, Nose and Throat Diseases. 12th Edn. New Delhi: Jaypee Brothers Medical Publishers

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

(p) Ltd.; 2013; 6–8, 12, 20, 21, 33, 34, 38– 40, 77p. Rushd AW. Kitab al-Kulliyat (Urdu Translation by CCRUM). 2nd Edn. New Delhi: CCRUM; 1987; 22p. Ervin SE. Assessment Tools: Introduction to the Anatomy and Physiology of the Auditory System. [Internet]. [Cited 201604-15] Available from: http://www.work placeintegra.com/hearing-articles/Earanatomy.html. Ahmad SI. Introduction to Al-Umur AlTabi’yah. New Delhi: CCRUM; 2009; 192, 193p. Chaurasia BD. Human Anatomy. Vol-3. 4th Edn. New Delhi: CBS Publishers and Distributers; 2004; 255, 256, 262, 264p. Ahmad FN. Manual of Practical Anatomy. Vol-3. 2nd Edn. New Delhi: CBS Publishers and Distributers Pvt. Ltd.; 2014; 252, 254, 256, 258p. Maroonroge S, Emanuel DC, Letowski TR. Basic Anatomy of Hearing System. [Internet]. [Cited 2015 12 18] Available from: http://www.usaarl.army.mil/pages/pu blications/HMDs/files/Section%2015% 0%20Chapter%208%20Ear%20Anatomy.p df. Garg S, Agrawal AK, Chadha S. Hearring Loss: Need for Action towards Primary Ear and Hearing Care. Sound Hearing 2030. 1st World Congress on Ear and Hearing Care, New Delhi. 2015; 36p. Arzani A. Tibbe Akbar (Urdu Translation by Hakim Mohammad Husain). Deoband: Faisal Publications; YNM; 209, 211, 212– 223, 226p. Anonymous. Standard Unani Medical Terminology. New Delhi. CCRUM; YNM; 256–258p. Multani HC. Tajul Hikmat. Lahore: Malik Book Depo Chauk Urdu Bazar; YNM; 72, 74, 76–78p. Bhargava KB, Bhargava SK, Shah TM. A Short Textbook of ENT Diseases. 6th Edn. Mumbai: Usha Publication; 2002; 84, 85, 87, 90, 98–101p. Anonymous. Anatomy and Physiology of Ear, Nose and Throat. [Internet]. [cited 2016 04 15. Available from: http://unilor in.edu.ng/publications/dunmade/course%2 0development.pdf. Khan Ghulam Jilani. MakhzanulIlaj. Vol-1

Page 37

Ear Diseases in Unani and Modern Perspective

29.

30.

31.

32.

33. 34.

35.

36.

37.

38.

39.

40.

and 2. New Delhi; Idara Kitab al-Shifa; 2005; 16, 147, 157, 158p. Wakode PT. Clinical Methods in ENT. New Delhi: Jaypee Brothers Medical Publishers (p) Ltd.; 2005; 23, 25–29p. Kirmani NA. Tarjuma Sharah Asbab (Urdu Translation by Hakim khawaja Rizwan Ahmad). Vol-2. New Delhi: CCRUM; 2010; 250, 254, 256, 263–266, 270–273, 281, 282p. Ibn Sina. Al Qanoon Fil Tib (Urdu Translation by Kantoori GH). Vol. 1–5. New Delhi: Idara Kitab al-Shifa; YNM; 642, 643, 644, 646, 647, 649, 654p. Arzani HMA. Mizan al-Tib (Urdu Translation by Hakim Mohammad Kabiruddin). New Delhi: Idara Kitab alShifa; 2002; 82–84p. Razi ABMZ. Kitab-ul-fakhir. Vol-I. New Delhi: CCRUM; 2007; 72, 77, 78, 83p. Qarshi AAHAA. Moojizal Qanoon (Urdu Translation by Kauser Chandpuri). 3rd Edn. New Delhi: Qaumi Council Bra-i Frogh Urdu Zaban; 1998; 293, 296p. Arzani A. Iksirul Qloob (Urdu Translation by CCRUM). New Delhi: CCRUM; 2010:70,71,611,612p. Qamri AMH. Ghina Muna Ma Tarjuma Minhajul Ilaj. New Delhi: CCRUM; 2008; 71–72, 75, 77, 80, 82p. Razi ABMZ. Kitab al-Mansoori (Urdu Translation by CCRUM). New Delhi: CCRUM; 1991; 40, 339, 341p. Khan HS. Ilajul Amraz (Urdu translation by Hakim Hadi Hasan Khan). 2nd Edn. New Delhi: CCRUM; 2005; 166, 167, 173p. Tabri AHAM. Al-Mualajat Al-Buqratiyah (Urdu Translation by CCRUM). Vol-1. New Delhi: CCRUM; 1995; 661, 693p. Razi ABMZ. Kitab-ul-Hawi (Urdu Translation by CCRUM). Vol-3. New Delhi: CCRUM; 1998; 10, 11p.

Aslam et al.

41. Qarshi MH. Jam-ul-Hikmat. Vol. I–II. New Delhi: Idara Kitab al-Shifa; 2011; 159, 483, 485, 487, 489, 490, 492, 494, 495p. 42. Majusi ABA. Kamil al-Sana'a (Urdu Translation by Kantoori GH). Vol-1. New Delhi: Idara Kitab al-Shifa; 2010; 137p. 43. Ahmad HHJ. Tazkirajalil. New Delhi: CCRUM; 2008:118p. 44. Iman HG. Ilajul Ghuraba (Urdu Translation by Mohammad Asghar Ibn Hakim Amir Ali). New Delhi: Idara Kitab al-Shifa; 2001; 48, 50p. 45. Razi ABMZ. Kitab Ma al-fariq aw alFurooq aw Kalam Fi al-Furooq Bayn alAmraz (Urdu Translation by CCRUM). 2nd Edn. New Delhi: CCRUM; 2009; 107p. 46. Qurrah SB. Zakhira Sabit Bin Qurrah. Aligarh: Litho Colour Printers; 1987; 115p. 47. Azam KHM. Rumooz Azam (Farsi). Vol-1. New Delhi. CCRUM; 2006; 177, 189p. 48. Zahrawi AQ. Jarahiyat-I Zahrawi (Urdu Translation by Hakim Nisar Ahmad Alavi kakorvi). New Delhi: CCRUM; 2012; 45, 47p. 49. Almaseehi AFIAQ. Kitab al-Umdah Fi’l Jarahat (Urdu Translation by CCRUM). Vol-1. New Delhi: CCRUM; YNM; 112p. 50. Anonymous. [Internet]. [Cited 2016-1101]. Available from:, http://www.thesinus doctor.com/7-great-habits-to-prevent-comm on-ear-diseases/

Cite this Article Mohammad Aslam, Basharat Rashid, Zarnigar et al. Description of Amraz-EGosh (Ear Diseases) in Unani and Modern Perspective: A Review. Research and Reviews: A Journal of Unani, Siddha and Homeopathy. 2017; 4(1): 31–38p.

Page 38