A distant city: Assessing the impact of Dutch socioeconomic developments on urban and rural health using respiratory disease as a proxy

Environment, Occupation, and Chronic Maxillary Sinusitis in Pre-Roman Italy

OBJECTIVE

To assess the frequency of chronic maxillary sinusitis (CMS) in a pre-Roman archeological skeletal assemblage from Italy and to evaluate the occurrence of CMS in combination with its environmental and sociocultural context.

MATERIALS AND METHODS

A total of 131 adult individuals from the pre-Roman site of Pontecagnano (eighth to third centuries bce) in southern Italy with intact maxillary sinuses of ≥ 50% preservation were macroscopically and microscopically observed for the presence of osseous changes per published diagnostic criteria of CMS.

RESULTS

CMS was present in 57.2% of individuals. The prevalence of CMS was higher in females than in males, and this difference was statistically significant (p = 0.043). The frequency of CMS increased with age-at-death. Bilateral CMS occurred more frequently than unilateral CMS. The differences in the prevalence of CMS in the Etruscan (700-450 bce), Samnite (450-375 bce), and final pre-Roman (375-200 bce) phases of occupation were not statistically significant.

DISCUSSION

In combination with viral and bacterial infections, occupational activities (metallurgy, ceramic and textile production, and agriculture) and environmental factors (volcanic ash, marshy environments, and sub-Saharan dust plumes) likely stimulated respiratory disease and resultant CMS in the inhabitants of Pontecagnano. This study provides a framework for future research on CMS and respiratory diseases in the Mediterranean region, in relation to environmental, climatic, and anthropogenic influences. The limited number of individuals per period prevented a proper diachronic analysis. Osteoarcheological assemblages from the Mediterranean region should be systematically analyzed for CMS to increase understanding of how climate, environment, industrialization, and urbanicity affected human health through time.

Historical Trends and Risk Factors in Chronic Maxillary Sinusitis Among Dutch Pre-Adults (475-1866 CE)

OBJECTIVES

This research examines the prevalence of chronic maxillary sinusitis in pre-adults from multiple Dutch sites, while also considering the effects of associated risk factors such as time period (i.e., urbanization), living conditions, and socioeconomic status. Our aim was to investigate how different risk factors impacted childhood upper respiratory health throughout the Dutch medieval and Post-medieval periods.

MATERIALS AND METHODS

We selected 13 sites representative of different time periods (475-1866 CE), living environments (i.e., rural and urban), and socioeconomic status to provide an in-depth overview of past Dutch societies. We macroscopically and endoscopically analyzed the maxillary sinuses of 227 pre-adult individuals to identify paleopathological signs of sinusitis. Adult data on chronic maxillary sinusitis from 11 of these populations were available for comparison.

RESULTS

Statistical analysis revealed that time period had the most noteworthy impact on sinusitis prevalence. Post-medieval pre-adults were nearly three times more likely to develop sinusitis than their early-medieval counterparts, while post-medieval adolescents faced an eightfold increase in risk compared to adolescents from earlier periods. Neither living environment nor socioeconomic status showed a statistically significant effect on sinusitis prevalence.

DISCUSSION

Our findings highlight the interplay of risk factors affecting respiratory health in pre-adults, contributing to a more comprehensive understanding of the historical burden of respiratory diseases in past populations. Factors such as increased population densities, limited access to resources (e.g., healthcare, nutritious food, and drinking water), and the institutionalization of child labor in the Dutch post-medieval period likely had negative impacts on the respiratory health of pre-adults.

Which types of bony changes in the maxillary sinus indicate chronic sinusitis?

OBJECTIVES

To determine which types of bone lesion (spicules, lobules, porous bone) in the maxillary sinus indicate sinusitis METHODS: Subadjacent dental disease is a cause of maxillary sinusitis; if a lesion type indicates sinusitis it should be more common above diseased posterior maxillary teeth than a lesion type that is not indicative of sinusitis. The study sample is a British Mediaeval human skeletal collection.

RESULTS

Porous bone lesions (chiefly new bone deposits) in maxillary sinuses are associated with subadjacent dental disease; spicules/lobules of bone in the sinus are not.

CONCLUSIONS

The results support the idea that porous lesions indicate sinusitis but the spicules/lobules may not. Spicules, lobules and porous lesions within the maxillary sinus should be analysed separately in biocultural studies; it would be prudent to regard only the porous lesions as indicative of sinusitis.

SIGNIFICANCE

Maxillary sinusitis is commonly used as a health indicator in palaeopathology, and spicular deposits are generally the most common type of alterations. By assuming that they are indicative of sinusitis we may have been greatly overestimating the prevalence of bony sinusitis in the past.

LIMITATIONS

These conclusions are provisional. Further work on larger, more diverse samples, together with more detailed anatomical studies on lesion location and structure is ongoing.

Chronic Maxillary Sinusitis: A comparison of osteological and CT methods of diagnosis

OBJECTIVE

To assess the differences between endoscopic and radiological methods of analysis for diagnosing chronic maxillary sinusitis (CMS) in archaeological skeletal remains.

MATERIALS

32 crania from a Dutch post-medieval rural population.

METHODS

We assessed the presence of bone changes indicative of CMS (i.e., bone growth and bone resorption) both endoscopically and through computed tomography (CT), and then compared results.

RESULTS

We observed moderate agreement between bone growth scores obtained through endoscopy and CT, and fair agreement when assessing bone resorption.

CONCLUSIONS

CMS prevalence rates observed through CT may be comparable to rates assessed endoscopically, although caution is needed when making direct comparisons.

SIGNIFICANCE

This is the first study comparing data obtained through endoscopy and radiological methods in the study of CMS, informing paleopathologists about potential biases in data comparison.

LIMITATIONS

Our small sample size likely impacted results.

SUGGESTIONS FOR FURTHER RESEARCH

Further research is advised to fully explore the comparability of endoscopic and radiological method of analysis in the study of sinusitis.

DATA AVAILABILITY

The datasets generated and analyzed during the current study are available upon request.