Ossicular chain changes revealed middle ear inflammation in medieval rural central Italy (Tuscany 10th-12th century)

To assess the prevalence of chronic otitis media in the medieval rural site of Pieve di Pava (central Italy) by analysing pathological changes in auditory ossicles and to investigate specific risk factors responsible for middle ear inflammation in a rural environment.

A total of 224 ossicles from 119 individuals (20 pre-adults and 99 adults) were examined.

Stereomicroscopic observation was used to evaluate osteoclastic and osteoblastic COM-related bone changes.

COM-related bone changes were observed in 52 ossicles, pertaining to 39 individuals (25 % of pre-adults and 34.3 % of adults), with no statistically significant difference between adult males and females. Pitting was the most common lesion-type (82.7 %), while new bone formation was less common (13.5 %).

Compared to urban medieval sites in western and northern-eastern Europe, the individuals from rural Pieve di Pava exhibited lower rates of chronic otitis media. This may be attributed to reduced exposure to urban-risk factors, such as indoor air pollution and overcrowding. Conversely, rural-specific factors, like farming, husbandry, and craft activities, might have influenced the observed prevalence.

The broad range of lesion-types on the ossicles and their severity helped us to provide diagnostic criteria for assessing COM in paleopathology.

The inability to examine all ossicles per individual, as well as the restricted number of pre-adults compared to adults.

Further archaeological population-based studies examining ossicles from different time periods and urban/rural settings across Mediterranean Europe could provide insights into the prevalence of chronic otitis media with a diachronic perspective.