Differential diagnosis of mastoid hypocellularity in human skeletal remains

Abstract

Mastoid hypocellularity is frequently used as an indicator of chronic otits media in paleopathological investigations. The condition can be caused by a poor development of air cells during infancy and early childhood (primary hypocellularity) or by obliteration of air cells with bone during later life (secondary hypocellularity). We performed a macroscopic, radiographic, and microscopic study of pneumatization patterns in 151 mastoid processes of individuals from an early-medieval cemetery in Germany, with emphasis on the architecture of the nonpneumatized portion of hypocellular mastoid processes. Two types of primary mastoid hypocellularity were distinguished. The first was characterized by a poorly defined boundary between the pneumatized portion and the nonpneumatized portion and a trabecular thickening in the spongy bone of the latter. The second showed a well-defined boundary between the pneumatized portion and the nonpneumatized portion and normal spongy bone architecture in the latter. The key feature for the diagnosis of secondary hypocellularity was the recognition of the walls of former air cells. Our observations closely match the histopathological findings by Wittmaack (Wittmaack: Uber die normale und die pathologische Pneumatisation des Schläfenbeins. Jena: Gustav Fischer [1918]), who developed a concept of the normal pneumatization process of the temporal bone and the pathogenesis of aberrant pneumatization. We agree with Wittmaack's view that two types of primary mastoid hypocellularity can be distinguished morphologically. Regarding the pathogenesis of these types, we, however, conclude that Wittmaack's concept needs to be revised and updated. Further studies are required to establish the relationship between morphological findings in cases of mastoid hypocellularity and the health status of individuals.

Panel 8: Complications and Sequelae

“…Hence, as stated by Flohr et al, 89 for evaluation of mastoid cells, discrimination of primary or secondary hypocellularity seems to be important. The authors stated that mastoid hypocellularity can be caused by poor development of air cells during infancy and early childhood (primary hypocellularity) or by obliteration of air cells with bone during later life (secondary hypocellularity).…”

Skeletal Evidence for Otitis Media in Mediaeval and Post‐Mediaeval Children from Poland, Central Europe

“…Mastoiditis has been repeatedly examined in archaeological populations as a sequela of OM (Rathbun and Mallin, ; Titche et al ., ; Gregg and Steele, ; Mann et al ., ; Homøe and Lynnerup, ; Flohr and Schultz, , ; Flohr et al ., ; Cullen Doyle and Judd, ). It most commonly results from AOM, but can develop also in consequence of COM (Flohr and Schultz, ; Casselbrant and Mandel, ; Qureishi et al ., ).…”

Ontogenetic Change in Temporal Bone Pneumatization in Humans

“…A boundary is evident between pneumatized bone and nonpneumatized bone and this boundary is often thickened, or sclerotic (Flohr et al, 2009). If this boundary is vague, one can search for the ostia, or openings between air cells, to ensure that nonpneumatized bone is not included.…”

“…Scientists have begun to revisit the subject of pneumatization in the past few years. Most of these newer studies focus on the paranasal sinuses (Farke, 2008;Rae and Koppe, 2008;Zollikofer and Weissmann, 2008;Smith et al, 2010), but there is an also emerging literature concerning pneumatization within the temporal bone (e.g., Balzeau and Grimaud-Hervé, 2006;Balzeau and Radovcic, 2008;Flohr et al, 2009).…”

“…The correlation between increased incidence of otitis media and reductions in temporal bone pneumatization in humans is the focus of extensive clinical research, as scientists are interested in reducing the incidence and risks of this condition (Hug and Pfaltz, 1981;Hug, 1986;Turgut and Tos, 1992;Bluestone and Klein, 1996;Bayramoglu et al, 1997;Sato et al, 1997;Homoe, 1999). Because the two phenomena are correlated, a reduction in pneumatization has been used to infer the presence of otitis media in paleopathological samples (e.g., Titche et al, 1981;Gregg and Steele, 1982;Homoe et al, 1995;Homoe et al, 1996;Flohr et al, 2009). In these studies, limited pneumatization represented by sclerotic bone (e.g., dense bone without large air cells) is taken as an indication of the existence of otitis media within the population.…”