Evidence of otitis media and mastoiditis in a Medieval Islamic skeleton from Spain and possible implications for ancient surgical treatment of the condition

Objective To evaluate lesions on a cranium from the Iberian Peninsula and assess its medico-historical and paleopathological significance.

Materials The skeletal remains of a juvenile individual found in a Medieval Islamic grave (10th -16th century) in Eastern Spain.

Methods Macroscopic examination of the left and right temporal bones, binocular microscopy, X-ray, and Scanning Electron Microscopy - Energy Dispersive X-ray Spectroscopy (SEM-EDS) were performed.

Results A sub-oval perforation superior to the right mastoid process and pathological changes on the right temporal bone were identified. SEM-EDS confirmed the presence of copper in the surrounding area of the perforation.

Conclusions The observed pathological changes are most likely compatible with otitis media and subsequent mastoiditis. The sub-oval perforation could be interpreted either as an abscess or as evidence of a surgical procedure (mastoidectomy) or a combination of both; and the Cu traces may be the result of an associated object or, possibly, the application of a plaster with copper acetate used as medical treatment.

Significance This case contributes to the paleopathological record and the interpretation of similar cases, and also helps in the understanding of medical care and treatment in Medieval Islam.

Limitations The lack of similar pre-modern cases of surgical intervention limits comparability to clinical cases.

Suggestion for further research: Exploration into indicators of health care in past populations