“Bulgy enlargement” and medieval hearing loss: Insights from Flohr and Kierdorf (2022)

 

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 21^st 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

Smooth or Spiky? November’s Sound Samples (12/2/24)

A cylinder ("smooth") and a spiky call-out box ("spiky")

As I have sought to be more intentional in my listening (and as my ear is gradually coming back online from that oh-so-long otitis media), I spent some time gathering samples of sound that struck me in particular ways. 

I’ll start with the sounds 

Example 1: Rain, in the middle of the night, in a tent:

 

Example 2: NYC, with honking cars and the murmur of the VERY crowded street:

Example 3: NYC, the background "swoosh" of street noise:

Example 4: LIRR (Long Island Rail) and its clackety clackety:

Example 5: Bird babbles on suburban Long Island:

What is interesting to me is the different emotional import of the various sounds. Rain is entirely soothing (except for the fact that it woke me up!); the randomness of it is restful, and quickly lulled me back to sleep. (It helped that the waterproofing worked!)

The NYC background noise of example 3, on the other hand, has much the same pattern of noise, with a relatively steady state of largely indistinguishable noises -- that city mix of traffic, the building being worked on, the walking noisy crowd, and so on. But the volume of that "swoosh" of noise is read by my viscera as a threat; the sheer volume (running at 70-90 decibels) is a pressure on my soul. Given my 'druthers, I'd rather listen to Example 2, the same ambient noise but with the disruptive honking of an aggressive cab. Why? I suppose it is partly because the spike in sound "fits" with my ground-level assessment of the city. It's at that level of "having a reason" for discomfort -- one can complain about the taxi, but it's harder to justify complaining about background sound -- even if it's nearly overwhelming.

The clacking railroad is back toward the comfortable zone of neutral noises; the cyclic nature of its sound is part of storytelling, after all: I think I can, I think I can, I think I can. Repetition is soothing, when it has a shape. Perhaps that puts the "swoosh" of street noise into context; being shapeless, there's nothing to listen for, just the inevitability of having to listen to the noises in an ongoing, unending way.

And then there's the recording of the bird babbles. These are happy birds (and some random squirrel tussling with a bush, click click), and they aren't particularly loud. There's an up and down to their individual calls, but they layer up as a mass of simultaneity. In music, it would be relatively dissonant; read as nature noises it fits into a category of the familiar. It's soothing, even if the assemblage is about as complicated as that of the city noises, with everyone talking at once.

The sounds we encounter at random shape us in ways we often don’t always consciously realize. They thread their way through our emotions and perceptive habits with their textures, patterns, and (especially) volumes. Reflecting on November's sound samples, I've been struck by the tangible interplay of smoothness and spikiness, and especially by how their combinations "read differently" depending on context. Repetition can soothe or grate depending on the narrative we assign it; randomness too can comfort or unsettle. Context lets us transform noise into music (sound organized in time) or cacophony (random unpleasantness), drawing on our emotions to do so. This is why the music sounds in clubs or restaurants can excite some patrons and utterly annoy others; they are placed differently within the internal narrative each listener brings to the moment.

This exercise in intentional listening has reminded me that soundscapes are as much about how we listen as about the sounds themselves. Rain becomes restful because I associate it with shelter and safety; honking cabs feel less intrusive than the city’s unrelenting roar because they narrate a story I can respond to. Even the chaos of bird babbles draws me in, not for its order, but for its vibrant vitality. (That dad’s a birder brings those sounds special meaning, and that’s relevant too!)

Sound, whether smooth or spiky, asks us to tune in—to its rhythms, to the silences (sometimes) interspersed within, and to the ways it resonates within us, both in a physical sense of vibrating WITH the train, and in an emotive sense of what memory/memories it pokes into recollection. Each sound carries its own emotional baggage; in listening carefully, we not only hear the world more clearly but perhaps hear our own inner thoughts as well.

There is no quiet, no silence anywhere within! (11/28/24)

Contradicting the title (There is no quiet!), a solo turkey walks across a park meadow with a tree backdrop

I’m quoting Ovid as the title to today’s post, and as a descriptor of today’s experience. Truly, truly, “There is no quiet, no silence anywhere within!”

Silence is golden, or so the adage goes. But does that really hold? Maybe not so much on a holiday day! The Thanksgiving holiday for us is combined this year with a 90^th birthday celebration for Grandpa Jack, our “walking talking medical miracle” who had had a whole host of reasons that walking around for a birthday party event is truly cause for celebration.

With 4 kids in each of two families and 2 in another – TEN children -- plus all (and I do mean ALL) of the adults, we have a whole array of stimulating wave-forms going on in a relatively small livingroom-dining room area. 86 decibels worth, on average. Yikes!

As is typical, I have grabbed my corner, and I expect that the seltzer water cans will pile up with me over the next several hours. The twins and the dog are doing something involving going in and out of the sliding door, there’s laughter in the kitchen and a bunch of bossy instructions about how better to do things, and the alcohol is abundant. Prosecco comes by the case in my in-laws’ household.

You can probably predict the noise of the TV, and the almost-drowned-out conversations, and the quick volunteerism of taking out the trash. Outside, the volume is diminished, the sheer chaos of the landscape shifting out toward calm.

And yet, to have quiet and silence on a celebration would be at odds with the spirit of the day. The noise – the energy, the conversations, the out-talking, out-competing, and out-maneuvering – IS the point of the gathering. Because that noise causes memories. 

Sound is the substrate for recollection. Just like the clink of glasses reminds of a former toast, the iPad a source of merry memories, or the snickering of cousins suggest that the cheating (ahem) just got out of hand in that game of Monopoly, sounds are Proustian prompts to our remembrances of yesteryear.

So us? We will look back and remember that Susan won the temperature battle on cooking the dressing, and that Griffin was feeding the Molly the Dog tidbits under the table, and that Ray and Rachel had stories of the city to share, and that Grandpa fell asleep during the football game. And that the singing and icecream cake woke him for another round of happy togetherness.

And our memories will be good.

My wish for all of you who celebrate:

May the noise and energy of your holidays echo in your memories for years to come.!

 

REFERENCE

Ovid Metamorphoses, vol. 2, transl. Frank Justus Miller, The Loeb Classical Library  (New York: G.P. Putnam’s Sons, 1926): vol. 2, pp. 184-185.

19th Century poetic earlids and the Ovid rumor-mill (11/26/24)

 

Image of James Henry, poet of Menippea (1866)

Henry, James. “It is just in Heaven to favor so the eyes.” [Poem written while walking from Revere to Verona, July 22 and 23, and in Dresden, Oct. 22, 1865]. Menippea. Dresden: C.C. Meinhold & Sons, 1866, p. 213-14. https://books.google.com/books?id=4G1MAAAAcAAJ&pg=PA213

If one is to spend time on earlids -- and evidently that’s on the current docket, as my previous posts show (see here and here) – one could do worse than to spend time with doctor-and-poet James Henry. His not-particularly-well-known poetry collection Menippea is a staunchly 19th-century product, and one of the untitled poems from the middle of the collection spends 54 lines considering earlids and their absence. 

I quote it here in its entirety:

…. “Nullis inclusit limina portis. Nocte dieque patent… Nulla quies intus, nullaque silentia parte.”

[There is no closing the thresholds of the gates. They are open day and night... There is no peace within, and no silence outside. -- Ovid, Metamorphoses, Bk 12, ll. 45-50]

Is it just in Heaven to favor so the eyes
With lids to keep out dust and glare and flies,
And leave the poor ears open, night and day,
To all each chattering fool may choose to say,
To all assaults of sturdy hurdygurd,                                          5
And grand-piano octave, chord, and third,
And rapid volley of well-quavered note,
Out of wide gaping, husband-seeking throat,
And fiddle squeak, and railway whistle shrill,
Big drum and little drum and beetling mill,                            10
Trumpet and fife, triangle and trombone,
And hiss and shout and scream and grunt and groan?
Be gracious, Heaven! And, if no law forbid,
Grant the distracted ear such share of lid
That we may sometimes soundly sleep at night,                    15
Not kept awake until the dawning light,
By rattling window-sash, or miauling cat,
Or howling dog, or nibbling mouse or rat,
Or cooped-up capon fain like cock to crow,
Or carts that down the paved street clattering go,                  20
Or nurse, in the next room, and sickly child,
Warbling by turns their native woodnotes wild.
Judge us not by thyself, who darest not sleep,
But open always, day and night, must keep
Both eye and ear, to see and hear how go                              25
All things above the clouds, and all below;
Lids for thine ears, as for thine eyes, were worse
Than useless, an impediment and curse;
We, with less care, our eyes are free to close
At night, or for an after-dinner doze,                                      30
And for this purpose thou hast kindly given,
And with a bounty worthy of high Heaven,
Each eye a pair of lids. One lid might do
For each ear, if thou wilt not hear of two,
One large; well fitting lid; and night and day,                        35
As bound in duty, we will ever pray;
And thou with satisfaction shalt behold
Our ears no less protected from the cold
Than our dear eyes, and never more need’st fear
That to thy word we turn a hard, deaf ear;                              40
Never more fear that discord should arise
And jealous bickerings between ears and eyes,
Both members of one body corporate,
Both loyal subjects of one church and state;
Never more see us, on a frosty day                                         45
Stuffing in cotton, or hear caviller say:
“I’d like to know why fallen less happy lot
On ear than on snuffbox and mustardpot;
What is it ever ear thought or ear did,
To disentitle it to its share of lid?”                                          50 
Earlids, kind Heaven, or who knows what --?? But no!
Silence, rebellious tongue, and let ear go
And plead its own case. Lidless, Heaven’s own ear,
And, whether it will or not, must always hear.

James’ use of Ovid as epigraph is only that of metaphor; Ovid doesn’t call to “earlids” specifically, but he does explore the realm of rumor. Rumor is available night and day, says Ovid; there’s no threshold closure to keep rumor out. Indeed, such murmurings amplify as we attend to them (as we must). In other words, gossip will have its sneaky way with folks.

Ovid, Metamorphoses Book XII [= Ovid on Rumor]

Orbe locus medio est inter terrasque fretumque
40 caelestesque plagas, triplicis confinia mundi;
unde quod est usquam, quamvis regionibus absit,
inspicitur, penetratque cavas vox omnis ad aures:
Fama tenet summaque domum sibi legit in arce,
innumerosque aditus ac mille foramina tectis
45 addidit et nullis inclusit limina portis;
nocte dieque patet; tota est ex aere sonanti,
tota fremit vocesque refert iteratque quod audit;
nulla quies intus nullaque silentia parte,
nec tamen est clamor, sed parvae murmura vocis,
50 qualia de pelagi, siquis procul audiat, undis
esse solent, qualemve sonum, cum Iuppiter atras
increpuit nubes, extrema tonitrua reddunt.
Atria turba tenet: veniunt, leve vulgus, euntque
mixtaque cum veris passim commenta vagantur
55 milia rumorum confusaque verba volutant;
e quibus hi vacuas inplent semonibus aures,
hi narrata ferunt alio, mensuraque ficti
crescit, et auditis aliquid novus adicit auctor.
Illic Credulitas, illic temerarius Error
60 vanaque Laetitia est consternatique Timores
Seditioque recens dubioque auctore Susurri;
ipsa, quid in caelo rerum pelagoque geratur
et tellure, videt totumque inquirit in orbem.

There is a place in the middle of the world, ’twixt land and sea and sky, the meeting-point of the threefold universe. From this place, whatever is, however far away, is seen, and every word penetrates to these hollow ears. Rumour dwells here, having chosen her house upon a high mountain-top; and she gave the house countless entrances, a thousand apertures, but with no doors to close them. Night and day the house stands open. It is built all of echoing brass. The whole place is full of noises, repeats all words and doubles what it hears. There is no quiet, no silence anywhere within. And yet there is no loud clamour, but only the subdued murmur of voices, like the murmur of the waves of the sea if you listen afar off, or like the last rumblings of thunder when Jove has made the dark clouds crash together. Crowds fill the hall, shifting throngs come and go, and everywhere wander thousands of rumours, falsehoods mingled with the truth, and confused reports flit about. Some of these fill their idle ears with talk, and others go and tell elsewhere what they have heard; while the story grows in size, and each new teller makes contribution to what he has heard. Here is Credulity, here is heedless Error, unfounded Joy and panic Fear; here is sudden Sedition and unauthentic Whisperings. Rumour herself beholds all that is done in heaven, on sea and land, and searches throughout the world for news.

Ovid Metamorphoses, vol. 2, transl. Frank Justus Miller, The Loeb Classical Library  (New York: G.P. Putnam’s Sons, 1926): vol. 2, pp. 184-185.

ANALYSIS:

James Henry may have been inspired by Ovid, but he goes his own way in the poem. He considers in the beginning the difference between eyes (with lids) and ears (without), and alludes to Ovid’s chattering fools who amplify rumors in so many difficult ways, but he moves quickly (lines 5-12) to the music that might be blocked out – the hurdygurdy, the piano and its chords, the voice and its ornamental runs (sung by a young lady to impress the men). Fiddles, percussion, brass band, and an array of other noises (“hiss and shout and scream and grunt and groan”) assault the ear.

He turns (lines 13-22) to thinking of the earlid, which could help us sleep by protecting us from household and neighborhood noises (blowing windows, cats and dogs, vermin, the neighbors chickens, night-time carts, and children – the urban equivalents through sheer pervasiveness of woodland sounds). We are not like God (lines 23-33), who needs to be always available and is omniscient; we’re able to tune out, to drop our attention and ignore the world around us. Even a single lid would be better for us, and we’d give thanks through prayer for having such a tool (lines 34-40). This happy circumstance would let us treat sight and hearing in parallel, both with the option of closing down at need. Thus, if snuffboxes and mustardpots warrant lids, don’t we humans too? (lines 41-50). But no, the poet concludes, we should be satisfied as-is; lidless ears we have, always open to the world around us – for good or for ill (51-54).

Earlids here are functioning as a poetic meditation on human vulnerability and connection. They start as a whimsical notion – a solution to the cacophony of life – but evolve into a reflection on how we stay open to the world around us. Henry’s playful logic – his comparisons to mustardpots and snuffboxes – underscores the absurdity of wishing away our inherent human-shaped design. Instead, the poem turns our "deficiency" into a virtue: our lidless ears remind us of our shared humanity. Because of their absence, we are (happily) unable to fully shield ourselves from the beauty and the clamor of existence. In a world of noise, our earlidless status keeps us tethered to both the chaos and the harmony around us. We are always listening, always, therefore, alive.

BIBLIOGRAPHY 

• Henry, James. “It is just in Heaven to favor so the eyes.” [Poem written while walking from Revere to Verona, July 22 and 23, and in Dresden, Oct. 22, 1865]. Menippea. Dresden: C.C. Meinhold & Sons, 1866, p. 213-14. https://books.google.com/books?id=4G1MAAAAcAAJ&pg=PA213

• Ovid Metamorphoses, vol. 2, transl. Frank Justus Miller, The Loeb Classical Library (New York: G.P. Putnam’s Sons, 1926): vol. 2, pp. 184-185.