Chronic maxillary sinusitis in palaeopathology: A review of methods

A comparative approach to bony changes in maxillary and frontal sinuses as indicators of upper respiratory health

OBJECTIVE

The central aspect of this study is to provide a detailed comparison of bony changes in the maxillary and frontal sinuses in human skeletal remains in an effort to assist researchers record lesions and assist with potential diagnoses.

MATERIALS

198 adult human remains from a medieval Avar population from Vienna, Austria.

METHODS

Analysis of bony changes using an endoscopic multifunctional camera with an ultra-small lens and adjustable LED lights.

RESULTS

Most common findings in both the maxillary and frontal sinuses are "pitting" and "white pitted bone". However, significant differences between the maxillary and frontal sinuses regarding the frequency and variation of bony lesions exist.

CONCLUSION

The maxillary sinuses exhibited significantly greater prevalence of bony changes compared to the frontal sinuses but frontal sinuses, which generally are less frequently affected by inflammatory, malignant, or benign lesions, may ultimately provide more informative insights in paleopathological studies concerning the health of the upper airways than the maxillary sinuses.

SIGNIFICANCE

Considering that most paleopathological studies on paranasal sinuses focus primarily on the maxillary sinuses, this study provides comparative data on the diversity of bony changes found in the frontal sinuses as a means to assist paleopathological recording and potentially eventual diagnosis.

LIMITATIONS

The lack of knowledge about the pathophysiological mechanisms underlying individual bony features complicates interpretation, particularly in paleopathological studies.

SUGGESTIONS FOR FURTHER RESEARCH

A further examination of all paranasal sinuses (including the sphenoid sinuses and ethmoidal cells) is recommended.

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.

Embracing complexity. Porous cranial lesions and their paleopathological significance in two population samples from Neolithic Northern Germany

OBJECTIVE

To assess phenotypic variation of porous cranial lesions and their co-occurrence with infections of the upper respiratory apparatus and endocranial lesions, to infer disease burden in two different Neolithic socio-economic groups.

MATERIALS

Human skulls of at least 111 individuals from a collective grave at Sorsum (farmers) and 30 individual biurials at Ostorf (aquatic foragers) from northern Germany (c. 3300-2900 BCE).

METHODS

A new data recording protocol for scoring porous cranial lesion phenotypic variation and the assessment of inter- and intra-site frequencies and anatomical distribution. Statistical analysis of lesion frequencies and co-occurrences.

RESULTS

High odds of porous cranial lesions and upper respiratory apparatus lesions co-occurrence, and of subperiosteal new bone formation of the vault (a porous cranial lesion phenotype) and endocranial lesions, are noted for both sites. Site-specific phenotypic profiles and distribution patterns differ. For Sorsum, juvenile individuals show greater porous cranial lesion frequencies and active lesions.

CONCLUSIONS

Considering disease interplay is key for understanding porous cranial lesion phenotypic variation. Disease profiles can be associated with subsistence strategies. The results rule out dichotomic models (e.g. "civilization stress") and support more nuanced reconstructions of the Neolithic social-economic transformations.

SIGNIFICANCE

This study emphasizes the need to adopt data recording protocols that include a wider range of porous cranial lesions to understand overlapping pathophysiological pathways.

LIMITATIONS

Considerable preservation bias of the population samples. Inter-observer error is to be tested. Radiographic analyses are needed to corroborate the results.

SUGGESTIONS FOR FURTHER RESEARCH

Further studies on larger assemblages from different geographical and chronological contexts are needed.

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.