Mastoiditis—Paleopathological evidence of a rarely reported disease

Abstract

Since antibiotics have become available, mastoiditis has become a rare disease in modern Western societies. However, it is still common in developing countries. It can be hypothesized that in earlier historical and prehistoric times, mastoiditis must have posed a serious threat to people's lives, and that the prevalence of this disease is probably underrepresented in the paleopathological literature. The present study identifies pathological changes in the pneumatized cells of the mastoid process in human skeletal samples from two early medieval cemeteries from Germany (Dirmstein: n = 152 mastoids, Rhens: n = 71 mastoids), using macroscopic, endoscopic, low-power microscopic, scanning-electron and light microscopic techniques, and draws some epidemiological conclusions as to the frequency of the disease diagnosed in the archaeological samples. Osseous changes because of mastoiditis were diagnosed in 83.4% of the temporal bones. The frequency in the skeletal sample from Dirmstein was higher than in the sample from Rhens. In both populations, males were more often affected than females and older individuals more often than younger individuals. The high frequency of mastoiditis observed was most likely due to an accumulation of osseous changes during individual lifetimes and supports the hypothesis that mastoiditis was a serious health problem in pre-antibiotic times. It may be assumed that subclinical forms of mastoiditis and their osseous manifestations may even nowadays occur more often than was previously thought. It is suggested that the disease should be given more consideration in paleopathological investigations.

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

“…In our study, mastoid pneumatisation pattern was evaluated on X‐rays. However, according to Flohr and Schultz (, ), a diagnosis of mastoiditis on the basis of a conventional X‐ray study might be inconclusive. They recommend a method based on longitudinal section of the mastoid.…”

Differentiating between rhinosinusitis and mastoiditis surgery from postmortem medical training: A study of two identified skulls and hospital records from early 20th century Coimbra, Portugal

“…It can be defined as acute or chronic, and is a consequence of otitis media, typically caused by the invasion of bacteria through the Eustachian tube into the tympanic cavity Schultz, 2009a, 2009b;Palma et al, 2014). Flohr and Schultz (2009a) identified bone alterations associated with mastoiditis in 83.4% of human skeletal remains from two early medieval German cemeteries, but with the introduction of antibiotic therapy, mastoiditis became a rare consequence of otitis media in the industrialized world, although it is still common in developing countries (e.g. Tarantino et al, 2002;Vassbotn et al, 2002).…”

A Knowledge of Bone at the Cellular (Histological) Level is Essential to Paleopathology

“…Applying microscopic techniques allows an even higher "resolution" to identify osseous changes (Flohr and Schultz 2009). But bone, like a single frame, can represent a record of past events.…”

“…woven or lamellar). They can be seen with sidelight under a powerful dissecting microscope, but better still using SEM (Figure 13.2, upper right) or thinsection microscopy (Flohr and Schultz 2009). By providing a simple description of the activity on bone surfaces, such as type of bone laid down and the location (endosteal, cortical or periosteal), important information can be added to other lines of evidence and improve a macroscopic differential diagnosis (Klepinger 1983).…”