Chronic maxillary sinusitis: a comparison of osteological and radiological methods of diagnosis

Today, Computed Tomography (CT) is a widely established technique to visualize pathological changes in archaeological human remains. The high definition of the current scanners allow for even small lesions to be visualized, therefore giving osteoarchaeologists a powerful tool to investigate disease in the past.The study of chronic maxillary sinusitis (CMS) has received significant attention in the past years as the presence of CMS is generally considered indicative or air quality. We discuss here the methodological implications of using CT scans for diagnosing CMS in contrast to classical endoscopical observation. A total of 32 crania from the Dutch post-medieval rural village of Middenbeemster (AD 1829-1866) were examined both endoscopically and through CT scans. Criteria for identifying CMS included presence of bone spicules and pitting on the sinus walls. 12 cases of CMS were identified endoscopically, and 19 through CT scanning. Statistical analysis revealed no significant differences in scoring CMS endoscopically or through radiographic imaging (τb=0.246, p=0.170). When investigating differences among features, no statistical difference was found between spicules observed through macroscopical analysis and computed tomography respectively (τb=0.246, p=0.170). The same analysis, however, revealed a statistically significant difference in endoscopically-assessed and CT-observed pitting (τb=0.374, p=0.037). Our results suggest that diagnosis of CMS on human skeletal remains can be confidently performed both through endoscopical and radiological analysis, albeit delivering better performances in scoring bone formation in contrast to bone resorption. Further research is being considered to fully explore the role of computed tomography in the study of CMS.