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.

Prevalence of chronic maxillary sinusitis in children from rural and urban skeletal populations in Poland.

Maxillary sinuses of 100 subadults from Cedynia, an early-urban site (stronghold), dated to the 10th-14th centuries AD, and of 28 subadults from Slaboszewo, a rural site, dated to the 14th-17th centuries AD, were examined for bone formation indicative of chronic sinusitis in order to explore the effect of urban and rural environments on the occurrence of upper respiratory tract infections in the past. We expected a higher prevalence of sinusitis in subadults from a stronghold than from a village, because of such factors as crowding, rapid spread of infections, and pollution from workshops located in the streets. We found a statistically non-significant tendency toward a higher prevalence of the condition in Cedynia compared to Slaboszewo (18.0% and 7.1%, respectively). The majority of maxillary lesions were classified as spicules. Changes to bone morphology suggestive of sinusitis of dental origin were not found. The development of observed osseous lesions may be attributed to culturally determined risk factors such as low quality of housing, air pollution caused by smoke from the household hearth and street workshops, poor levels of hygiene, and water contamination.

A bioarcheological study of maxillary sinusitis.

Maxillary sinusitis was studied as an indicator of poor air quality. Seven skeletal samples were examined from North America, England, and Nubia, and selected to represent different geographic locations, environments, and subsistence economies. Frequency rates varied from 17.2 to 51.5% of individuals affected with one or both sinuses preserved. Hardin Village had the highest frequency (51.5%), followed by the Aleuts (42.9%), "Illinois" (38.6%), Indian Knoll (38.5%), Kulubnarti (21.8%), Christchurch, Spitalfields (18.0%), and "South Dakota" (17.2%). Male frequencies ranged from 16.7 to 36.7%, but the female frequency ranged more widely from 18.0 to 76.5%. At most sites female rates exceeded male. The effect of urban and rural environment on sinusitis occurrence, and also subsistence economy, biological sex, and social status were explored, and comparative sites also considered; urban agricultural sites had a mean frequency of 48.5%, rural agricultural sites had a mean frequency of 45.0%, and hunter-gatherer sites had a mean frequency of 40.0%. In the urban sites male and female frequencies were near equal, but in the rural agricultural and hunter-gatherer sites female frequencies exceeded male frequencies. Dental disease was not found to have much impact on sinusitis frequency. The importance of the link between poor air quality and respiratory health is highlighted in clinical studies in both developed and developing countries, but also in bioarcheological studies.

The evolution of surgery on the maxillary sinus for chronic rhinosinusitis.

OBJECTIVE: To examine the management of the maxillary sinus in chronic rhinosinusitis over the last 500 years. METHOD: A literature review was conducted. RESULT: The maxillary sinus was first recognized in the 16th century and its role as a source of infection became the focus of attention, beginning with Nathaniel Highmore in 1651 and continuing up until the 21st century. The surgical drainage of the sinus was achieved by a variety of routes, including the alveolar margin, anterior wall and middle and inferior meati. The rationale for these procedures, developed in a pre-antibiotic era, may be re-examined in the context of our present understanding of the pathophysiology of chronic rhinosinusitis. CONCLUSION: The maxillary sinus has been the focus of surgical attention from the 17th century onward largely as a result of its size and accessibility, initially reinforced by plain x-ray. However, in the 20th century, the advent of computed tomography and nasal endoscopy has reaffirmed the relationship of the maxillary sinus to the ostiomeatal complex in chronic rhinosinusitis, as originally demonstrated by pioneers such as Zuckerkandl, and redirected the focus of our therapeutic approaches.

Maxillary sinusitis in Medieval Chichester, England.

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.

Comparative study of the prevalence of maxillary sinusitis in later Medieval urban and rural populations in northern England.

Six hundred sixty-three Medieval individuals from Wharram Percy, a rural settlement in the Yorkshire Wolds, and 1,042 individuals from St. Helen-on-the-Walls, a poor parish in the Medieval city of York, were examined in order to test the hypothesis that maxillary sinusitis would be more prevalent in an urban population due to social and environmental conditions characteristic of an industrialized settlement. The results showed that the individuals from St. Helen-on-the-Walls, living in the urban environment, had a greater prevalence of maxillary sinusitis than the rural population; 39% (106) of the individuals from Wharram Percy had evidence of sinusitis compared to 55% (134) of the individuals from St. Helen-on-the-Walls. It is suggested that this pattern may be attributed to occupation and industrial air pollution in the Medieval city of York.

Prevalence of maxillary sinusitis in leprous individuals from a medieval leprosy hospital.

The maxillary sinuses of 133 skeletons from the medieval hospital of St. James and St. Mary Magdalene, Chichester, England, were analyzed for evidence of sinusitis. Of the sample, 16 individuals were considered to have suffered from lepromatous leprosy and 13 from tuberculoid leprosy. The most common bone change seen within the sinuses was the presence of new bone formation followed by pitting. Bone change was seen in 56.3% (9 of 16) of the individuals with lepromatous leprosy and 54.8% (57 of 104) of nonleprous individuals. These results are not statistically significant. Clinical evidence suggests that one should see a higher frequency in the lepromatous group. Possible explanations of this include environmental factors promoting the spread of droplet infection in an immunosuppressed community, in addition to which the small sample of leprous skeletons may bias the result.

Some historical aspects of the surgical treatment of the infected maxillary sinus.

Sinus surgery probably originates from the time of the New Kingdom of ancient Egypt. Instruments were used to remove the brain through the nose as a part of the mummification process. The interest in the pathology of the maxillary sinus started to rise in the 17th century. Antral trephination for suppuration was the most common maxillary sinus operation in that period. An oro-antral fistula was often created by the extraction of a molar to drain the infected maxillary sinus daily. Later on the anterior wall of the maxillary sinus was opened through the canine fossa and was kept open for irrigation. Caldwell (1893), Scanes Spicer (1894) and later Luc in 1897 closed the canine fossa incision after an intranasal antrostomy and the removal of the infected mucosa. This so-called Caldwell-Luc procedure is still the most commonly used maxillary sinus operation today. After the introduction of the endoscopy in the beginning of this century endonasal surgery has been developed in the last decades into one of the important surgical procedures for maxillary sinus infections today.