Matskási István (szerk.): A Magyar Természettudományi Múzeum évkönyve 82. (Budapest 1990)

Pap, I. ; Józsa, L.: Occurence of otitis media, mastoiditis and alterations of auditory ossicles in some early Medieval series (Hungary)

DISCUSSION The lack of pneumatization and eburnification of processus mastoideus, destruction of middle ear's wall are the results of recurring and chronic otitis media (and its spreading on the mastoideum) (GREGG et al. 1965, SCHULTZ 1979a, GREGG & STEELE 1982). As half of the examined skulls showed traces of otitis and/or mastoiditis we assume that half of the population analyzed must have suffered from a frequently recurring chronic inflammation of the temporal bone. This incidence is approximately the same as the frequency established by GREGG & STEELE (1965, 1982) for pre- and post-Columbian Indian material. On a recent population BECSKE (1989) found a correlation between the location of ear drum perforation and the frequency of ossicle damage. He, as well as we, concluded that incus suffered damage the most frequently while stapes did it the least frequently. Of course it is not possible to locate the destruction of the ear drums in skeletal material but the high frequency of ossicle damage (incus: 52.2%, malleus: 34.4%, stapes: 21.1%) indicates the Shrapnell-membrane as its most probable location. The unilateral localization was comparatively rare. The majority of the cases carried traces of bilateral processes. We found unilateral disorder with an approximately two-year-old child and with one adult male and one mature female individual. Males were affected as much as females. Chronic otitis and mastoiditis were the most frequent among individuals who died in mature age. SCHULTZ (1979) found that the frequency of diseases of processus mastoideus and middle ear appears to rise with increasing age. Ear ossicle damage deserves special emphasis among the results of chronic otitis mastoiditis. Half or two-thirds of the ossicles belonging to otitis affected middle ears presented pathological characteristics. Incus lesions were the most frequent. The combined analysis of middle ear, processus mastoideus and ear ossicles led us to conclude that at least half of all individuals were hard of hearing, and one of them had unilateral deafness in consequence of stapedial footplate fixation. Otosclerosis with footplate ankylosis is frequently resulting in a conduction type of hearing loss and deafness (HOLZHUETER et al. 1965, BIRKBY & GREGG 1975). Other early Árpád period data indicated a 2.5% ratio of deafness (JÓZSA 1988). It roughly corresponds to the 4% frequency we found. SCHULTZ (1979b) considers porotic hyperostosis caused by iron deficiency anaemia found in a four-year-old pre-Columbian child (EL-NAJJAR et al. 1976) a probable etiological factor in pneumatic disturbance of processus mastoideus. We agree with the opinion that recurring and chronic otitis media causes the lack of pneumatization of mastoideum (GREGG & STEELE 1965, 1982; LYNN & BENITEZ 1974, SCHULTZ 1979b), adding that chronic otitis media could play a part in the occurrence of iron deficiency anaemia and therefore in the development of porotic hyperostosis. We found no trace of severe, septic complications: such as mastoid abscess, fistula or otogenic pyencephalus

. There was no correlation between chronic nasosinusitis and otitis media. The results of chronic inflammation of maxillary sinus were traceable only with 2 of the 13 otitis affected cases . Plate III. 7= Normal ossicles (magnification 20x). - 8= Clearly visible arthrosis on the neck and joint surface of a stapes (magnification 40x). 9= Arthrosis of processus articularis of incus (magnification lOOx). 10= Arthrotic facies articularis of incus (magnification 40x). - 11= 40 degrees axial deviation of manubrium of malleus (magnification 40x) Annls hist.-nat. Mus. natn. hung.. 82, 1990