Maxillary sinusitis in Medieval Chichester, England

Abstract

Maxillary sinusitis is a common medical complaint, affecting more than 30 million people per year in the United States alone. Very little palaeopathological work on this disease has been carried out, probably because of the enclosed nature of the sinuses in intact skulls and the lack of a suitable method for examination. This study tested the hypothesis that maxillary sinusitis was more common in people with leprosy than in people without it in Medieval England. The prevalence of maxillary sinusitis by age and sex was recorded in 133 individuals, some diagnosed as being leprous, derived from a later Medieval (12th to 17th centuries AD) urban hospital population at Chichester, Sussex, England using both macroscopic and endoscopic methods of examination. Of the 133 individuals with one or both sinuses available for examination, 54.9% (73) had evidence of bone change within the sinuses. There was no difference in prevalence between those with leprosy and those without, although clinical studies suggest that over 50% of lepromatous leprous individuals may develop sinusitis. Comparison with another study on Medieval British sites with a 3.6% prevalence (3 of 83) indicates that the prevalence at Chichester is much greater. The problems with diagnosing sinusitis are addressed and reasons behind the high frequency in this study are discussed. Aetiological factors predisposing to maxillary sinusitis are considered with reference to possible environmental conditions prevailing in the later Medieval period in Britain.

An unusual exostotic lesion of the maxillary sinus from Roman Lincoln

“…The often-chronic nature of mucosal infection increases the likelihood of changes to bone occurring within the sinus cavities (Ortner and Putschar, 1981;Roberts, 2007). However, it is generally assumed that the actual frequency of past sinusitis is underestimated due to the enclosed nature of the sinuses when undamaged (Boocock et al, 1995). An exostotic lesion of the type observed in this case is very uncommon in modern clinical literature (Tovi et al, 1992;Moretti et al, 2004).…”

“…Inflammatory osseous responses to pathogenic processes, including those affecting the maxillary sinuses, have been observed in the skeletal remains of many past populations (Boocock et al, 1995;Merrett and Pfeiffer, 2000;Roberts, 2007). The often-chronic nature of mucosal infection increases the likelihood of changes to bone occurring within the sinus cavities (Ortner and Putschar, 1981;Roberts, 2007).…”

Growth and health status of children and adolescents in medieval Central Europe

“…6) (Boocock et al 1995a;Merrett and Pfeiffer 2000;Roberts and Manchester 2005, p. 174;Sundman and Kjellstrom 2013a, b). Sinusitis is an inflammation of the mucosa of the paranasal sinuses, involving both infectious and noninfectious mechanisms.…”

Maxillary Sinusitis from India: A Bio-cultural Approach

“…Confirmation is possible either by CT (Computed Tomography) or with the help of endoscopy, which are very expensive methods. There are some studies conducted on the pathology of maxillary sinusitis on skeletal collections from medieval Europe and America [1,2,8,[12][13][14][15][16][17]. In India, the work on this pathology has received academic attention only in recent times.…”

“…While describing various etiologies of sinus, Roberts [1] mentions that immunodeficiency disorders [28] and infections such as leprosy [13,29] influence the onset of infection in the maxillary sinus. There are reservations and discussions on the relationship between the presence of leprosy and sinusitis together in one individual.…”