Non-specific inflammatory markers in remains from Ducové site (Slovakia): a bioarchaeological study of sinusitis in paranasal sinuses from the Late Bronze Age to Modern times

Archaeological and Anthropological Sciences (2025) 17:87 https://doi.org/10.1007/s12520-025-02210-w RESEARCH Non-specific inflammatory markers in remains from Ducové site (Slovakia): a bioarchaeological study of sinusitis in paranasal sinuses from the Late Bronze Age to Modern times Michaela Dörnhöferová1 · Lucia Majláthová2 · Silvia Bodoriková1 Received: 25 June 2024 / Accepted: 16 March 2025 / Published online: 22 March 2025 © The Author(s) 2025 Abstract The aim of this study was to assess the prevalence of chronic sinusitis in an osteoarchaeological sample from the Kostolec cemetery in the Ducové village (Slovakia) dated from the Late Bronze Age (1250–1000 BC) to the Modern Age (mid 16th–mid 19th century AD). The skeletons of 1,746 individuals were examined: 13 from the Late Bronze Age (LBA), 28 from the Great Moravian Period (GM), 1,468 from the Medieval Period (M) and 237 from the Modern Age (MA). The prevalence of sinusitis was 11.11% in the LBA, 45.00% in the GM, 38.39% in the M, and 37.16% in the MA population. There were no significant differences between males and females. The hypothesis of an increasing prevalence of sinusitis with increasing age was confirmed in two populations (the M – p = 0.0001; the MA – p = 0.0038). This trend may be due to the longer exposure of older people to adverse external and internal environmental factors. In both adults and non-adults, the maxillary sinuses were the most frequently affected. The high prevalence of inflammation in the maxillary sinuses may be explained by the fact that they are mainly affected by nasal and also odontogenic infections, in contrast to inflammation in the frontal or sphenoidal sinuses, which are rare. Keywords Non-specific inflammation · Chronic respiratory diseases · Environment · Rural population · Central Europe Introduction Recently, chronic respiratory diseases have become the third leading cause of death worldwide (Riccomi et al. 2021; GBD 2020). Chronic sinusitis is a common but often underestimated health problem in Europe, with significant medical costs and impact on quality of life. The overall Michaela Dörnhöferová Lucia Majláthová Silvia Bodoriková 1 Faculty of Natural Sciences, Department of Anthropology, Comenius University, Ilkovičova 6, Mlynská dolina, Bratislava 842 15, Slovakia 2 Faculty of Science, Department of Anthropology and Human Genetics, Charles University, Viničná 7, Prague, Czech Republic prevalence of chronic sinusitis in Europe is estimated to be around 10.9%, with considerable geographical variation ranging from 6.9 to 27.1%. This means that approximately one in ten adults in Europe suffers from chronic sinusitis (Albu 2020; Hastan et al. 2011; Dietz de Loos et al. 2019; NCZI 2022). Respiratory diseases can result from a variety of causes, including allergies, immune deficiencies, bacterial infections or viral infections (such as the common cold, which can lead to persistent sinusitis), exposure to pollutants and irritants (such as pollen, smoke, or dust; Battisti et al. 2023; Whyte and Boeddinghaus 2019). Historical documentation shows that people have long been aware of environmental pollution and its effects on health. As early as the 5th century BC, Hippocrates addressed this issue in his work “Airs, Water and Places” (Lloyd 1978; Davies-Barrett 2018). Respiratory disease as an indicator of poor air quality, which is a major concern today, has received relatively little attention in the bioarchaeological record, probably because most human remains from archaeological sites are skeletal and few skeletal markers of respiratory disease can be identified (Davies-Barrett 13 87 Page 2 of 15 2018, 2021). In bioarchaeology, the presence of pitting or new bone formation on the visceral surface of the ribs and the internal surface of the maxillary sinuses is generally accepted as an indicator of non-specific lower and upper respiratory disease. Sinusitis could be a useful indicator for assessing respiratory health, as its osseous manifestation is associated with chronic inflammation of the sinuses (Buikstra and Williams 1991; Pfeiffer 1992; Kelley et al. 1994; Roberts 1999; Capasso 2000; Santos and Roberts 2001, 2006; Lambert 2002; Matos and Santos 2006). Sinusitis (sinusitis paranasalis) is classified as an inflammatory disease of the paranasal sinuses. Sinusitis is divided into acute (symptoms resolve within 12 weeks) and chronic inflammation (symptoms persist for 12 weeks or longer). Sinusitis affects 5–15% of cases in children and adults (Yaremenko et al. 2015), and 10% of the population in Central Europe (Sičák 2006; Bachert et al. 2020). It is caused by a combination of environmental and host factors. It is primarily caused by infections of the upper respiratory tract. Acute sinusitis is most commonly caused by viruses and is usually self-limiting. Approximately 90% of patients with the common cold have an element of viral sinusitis, which develops due to the accumulation of mucus and infectious agents, resulting from the inability to remove this mixture of mucus and agents through the small drainage canals leading into the nasal cavity due to their blockage. Viral infections of the upper respiratory tract and bacterial infections (e.g., Streptococcus pneumoniae, Staphylococcus aureus), odontogenic focal infections, immune deficiencies, trauma, asthma, nasal obstructions (e.g., nasal polyps, foreign bodies in the sinus), anatomical variants of the nasal cavity as well as fungal allergies and pollutants are also considered potential triggers of sinusitis (Battisti et al. 2023; Sičák 2006; Whyte and Boeddinghaus 2019; Slavin et al. 2005; Al-Abri et al. 2014). The wall of a healthy sinus is a smooth and regular compact bone with impressions of blood vessels and nerves. During tissue regeneration and recurrent inflammations, damage to the mucosa occurs, which also affects the bone tissue, due to dysregulation of cytokine interaction: interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-ß (TNF-ß), transforming growth factor ß (TGF-ß; Brandtzaeg et al. 1996). IL-1, IL-6, and TNF-ß stimulate osteoclast proliferation and activation, while TGF-ß increases osteoblast production (Gowen 1994). The presence of bone in the paranasal sinuses is associated with chronic sinusitis lasting more than 12 weeks (Kwon and O’Rourke 2020). Most studies focus on the occurrence of inflammation in the maxillary sinus because it is primarily affected by infections from the nasal cavity, unlike other sinuses which are much less affected. Sinusitis, along with periostitis, endocranial osteogenesis, and otitis media, is commonly used as 13 Archaeological and Anthropological Sciences (2025) 17:87 a non-specific infection to determine health status in subadult bioarchaeological studies. In children, the most common predisposing factor for sinusitis is an upper respiratory tract infection (Ortner 2003). Chronic maxillary sinusitis is well documented in archaeologicall (...truncated)