Statistical Model Estimating the Occurrence of Otitis Media from Temporal Bone Pneumatization

Abstract

In order to investigate the relationship between the pneumatization of temporal bones and the occurrence of otitis media in Greenlandic Inuit, 36 Greenlandic Inuit were examined by radiography of the temporal bones. The pneumatized cell area was measured planimetrically. All subjects answered a questionnaire on infectious middle ear disease (IMED), and an objective otologic examination was performed. Nine persons of 34 (26%) reported IMED in childhood, and there was IMED reported in all pneumatized areas below 400 mm2. Based on bilateral area measures, a polychotomous logistic regression model was applied. The occurrence of IMED was shown to be associated with smaller areas, and unilateral IMED was associated with pronounced asymmetry. The model has enabled risk assessment, and 8 persons were designated by the model as having had IMED with a sensitivity of 67% (confidence interval 30% to 93%) and a specificity of 92% (confidence interval 74% to 99%). When the model was applied to a historical anthropological Inuit material from 1700 to 1800 AD, 6 of 56 crania were designated as having had IMED. This method has improved the accuracy of estimating the occurrence of IMED in ancient populations.

Mastoiditis—Paleopathological evidence of a rarely reported disease

“…Homøe and coworkers observed frequencies of AOM of 75-90% in recent Inuit children younger than 3 years (Homøe et al, 1994). These frequencies are similar to those for the osseous changes in the pneumatized mastoid cells observed in the present study and reflect the widely accepted view that middle ear diseases are among the most common diseases of children in general.…”

“…Corresponding to clinical practice, also in investigations on ancient skeletal remains, radiographs are most commonly used to identify pathological conditions in the middle ear region, including the mastoid process (e.g., Gregg et al, 1965;Rathbun and Mallin, 1977;Titche et al, 1981;Homøe and Lynnerup, 1991;Schultz, 1993;Homøe et al, 1994Homøe et al, , 1995Homøe et al, , 1996. However, many of these studies focus on the degree of pneumatization in the mastoid region as an indicator for the occurrence of a chronic disease in the middle ear (COM).…”

“…However, many of these studies focus on the degree of pneumatization in the mastoid region as an indicator for the occurrence of a chronic disease in the middle ear (COM). Indeed, an exceedingly strong correlation between hypocellularity and COM has been repeatedly reported, including studies on individuals from pre-antibiotic times (Albrecht, 1924;Hanse, 1930;Stix, 1935;Weber, 1943;Fleischer, 1979;Homøe et al, 1994). Hypocellularity resulting from an inhibition of the pneumatization process or strongly asymmetrically developed pneumatization of the mastoids is related to the presence of a pathologically altered mucous membrane because of severe or recurrent middle ear infections during early childhood.…”

Histomorphometric Estimation of Air Cell Development in Experimental Otitis Media

“…Clinical studies have examined the effects of otitis media and air pressure on the pneumatization of the human MEACS. X‐ray planimetry suggested a correlation between diminished pneumatization of the middle ear spaces and the occurrence of recurrent acute otitis media or secretory otitis media with effusion 1–3 . Prospective studies of children with secretory otitis media found that subsequent insertion of a grommet resulted in greater pneumatization 2,4,5 …”

Differential diagnosis of mastoid hypocellularity in human skeletal remains

“…Comprehensive investigations on pneumatization patterns in recent and historical Inuit populations were performed by Homøe and colleagues (Homøe and Lynnerup, 1991;Homøe et al, 1994Homøe et al, , 1995Homøe et al, , 1996Homøe et al, , 2001. Based on their results in living people, these authors developed a model that allowed them to infer the presence or absence of COM based on pneumatization patterns in dried skulls.…”