 |
| Bulgy enlargement of ear canal signaled by black arrows (from Flohr and Kierdorf 2022) |
This post is a response to (and a brief meditation on) the recent work of Flohr and Kierdorf on two medieval skeletons showing signs of hearing loss:
Flohr, Stefan, & Kierdorf, Uwe. (2022). Abnormal bone loss in the external auditory canal of two adult humans from the medieval period of Germany—An attempt at differential diagnosis. International Journal of Osteoarchaeology, 32(4), 938–943. https://doi.org/10.1002/oa.3108
Since I’ve just spent a lively month developing a music and madness unit within our music history course for majors, I’ve already been reading and thinking a lot about paleopathology and diagnosis of illnesses of the past and their implications for human experience.
So, when I tripped across the Flohr and Kierdorf article on bone loss in the ear from the middle ages, it was sitting smack dab in the middle of some weird Venn diagram of transient interests.
- Ears and hearing, check.
- Past illnesses, check.
- Medieval, check.
- Soundscapes (and their absence), check.
TBH, I’m in it for the weird facts. I am not a medical person, nor do I play one on TV; I come at this as a humanist, and as someone still –STILL – bothered by ear issues of my own (Today makes it four months of otitis media and associated tinnitus, egad).
TWO DISEASES, TWO DIFFERENT EXPERIENCES
So, in the “learn something new every day” category, there are two separate diseases that can cause external auditory canal problems. External ear canal cholesteatoma (EACC) is the one most commonly diagnosed out of the past, whereas their finding of keratosis obturans in one of the skeletons is new.
Keratosis obturans, I learned from Piepergerdes et al. (1980), is a disease in which keratin (that stuff from hair and nails) accumulates in the ear, causing acute biting pain and hearing loss. It gradually forces the external auditory canal to widen, but doesn’t actually damage bone.
EACC, on the other hand, is (layman translating): skin overgrowth that inflames the area wrapping around the ear bones – periosteitis, in other words. It’s sort of like having shin splints, but in your ear. Symptoms are more an ache than an ow, plus hearing loss. This is the one that causes osteonecrosis – the bone can be damaged and deteriorate if it’s left untreated.
Of the two diseases, Keratosis obturans is more common than EACC, at least in the 21st century. However, it has been missing in the paleopathology record until now.
WHAT THEY FOUND
Flohr and Kierdorf point out that both Keratosis obturans and EACC lead to enlargement and perforation of the external auditory canal wall. They call that expansion “bulgy enlargement,” and call it out in their images (as shown in the title card for today's blog post, above).
The “why” of that skeletal deformation seems obvious to a layman (me) when you look at the way that “stuff” fills up the ear canal in Keratosis obturans. Chartrand’s Figures 5 and 6 give you an idea of how that works – the left image is several months in, the right hand one is at 5 years. Can you even imagine? Oy! Modern images from Chartrand 2013
 |
| Chartrand's images of Keratosis obturans at 4 mo. and 5 yrs |
For this study, Flohr and Kierdorf examined two medieval skeletons:
- The first skeleton was of a 6th-8th c woman age >50. Her skeleton comes from a well-studied town graveyard.
-
The second was a man
age >50 from the monastery of St. Lorenz at Schöningen.We don't know if he was a monk or a lay brother; we just know that he was buried in the monastery graveyard some time (unspecified) in the late Middle Ages.
While both had “bulgy enlargement” of the ear canal, the second skeleton also had involvement of the mastoid, but the first didn’t. In other words, the woman had Keratosis obturans, and the man had EACC.
WHY IT MATTERS
The “why” provided by Flohr and Kierdorf is all about the ability to distinguish one disease from another, and that’s remarkably cool. Distinguishing between these diseases enriches our understanding of health conditions in the past, and theirs was the first to find Keratosis obturans in the archaeological record. Nifty stuff!
My own “why” is a little bit different, though. I’m thinking about the ways in which these two medieval individuals experienced the world around them.
The woman with Keratosis Obturans would have been hard of hearing, that bugaboo of the aging process. But she’d also likely have had moments of “the twitch,” that head jerking response to stabbing pain in the ear. Such pain may not have intruded very often, but she was living with pain as a regular occurrence. The world around her might still have been beautiful, but she would surely have had moments of wishing she could hear the bird singing, or follow the conversation more closely, and other moments of just wishing it would all stop. Ear pain can be the worst. Keratosis obturans was for her likely a loss, and one that plagued her on a regular basis. On the other hand, as they say, each day above the ground is a day for celebration.
The monastic man with EACC (who had also had several broken ribs, a broken arm, and other signs of hard living) was similarly hard of hearing, but his ear only ached. He too would have missed the birds, and frustrated his companions in his inattention and jumbled responses to conversational gambits. But for him, the ache of old bones and the ache of the ear might have been apiece, similar in their experiential implications. Getting old is not for the faint of heart.
A WORLD MADE MUFFLED
What’s amazing is to think about the fact that we have these clues into the sound-world of these older medieval individuals just by the signs and signals of the bones they left behind.
For both individuals, we can tell that the vibrant soundscapes of youth were now behind them; they lived in a muted world.
Given its more muffled nature, the world would have had mysterious almost-sounds that they’d be trying to decipher.
They’d mix up conversational answers because they were only guessing at what the person speaking to them had said. That can be embarrassing and can also strain relationships.
They might have developed some skill with lipreading (it’s a godsend, truly), but it doesn’t fully make up for what one hears through the ears, and the world goes silent when you turn around to write on the board – oh wait, that’s me. Try, … and the room went silent when when they turned to pick up the water pitcher.
Knock-to-enter might not have worked as a signal any more; overall acoustical signals would have become increasingly unreliable as time went by.
In particular, their use of the natural world and its auditory signals was no longer reliable. The sudden hush of the adjacent forest as a predator (or really any big bulky critter) comes through might not have grabbed their attention as it would have in their youth; they might have been unaware of the bleating lamb needing attention; the call of the rooster in the morning might not have served as wake up call now that the sound didn’t penetrate through as once it had.
SKELETON STORIES
In short, these skeletal clues offer something remarkable: a glimpse into the lived realities of medieval individuals as shaped by their embodied experience and its relationship to the world around them. The stories etched (or pressed) into bone invite us to imagine what it meant to listen, to strain to hear, to ache and hurt, and yet to adapt in a time not so very different from our own.
BIBLIOGRAPHY
Chartrand, Max Stanley. “Beware the Septic Keratosis Obturans: Stealth Public Health Threat” (March 2013): DOI: 10.4172/2161-119X.1000283
Flohr, Stefan, & Kierdorf, Uwe. Abnormal bone loss in the external auditory canal of two adult humans from the medieval period of Germany—An attempt at differential diagnosis. International Journal of Osteoarchaeology, 32(4) (2022): 938–943. https://doi.org/10.1002/oa.3108
Piepergerdes, M C et al. “Keratosis obturans and external auditory canal cholesteatoma.” The Laryngoscope vol. 90,3 (1980): 383-91. doi:10.1002/lary.5540900303
