[Acute and chronic middle ear pathology in mediaeval man (author's transl)].
The variety, extent and consequences of middle ear cleft disease in ancient times is reviewed. The findings of macroscopic radiological and scanning electron microscopic examination of skeletal material from two south German Merovingian populations and two pre-Columbian population groups from the south west of North America are presented. The possibility of false diagnosis was considered. Cases previously described are reviewed, summarized and compared. In both the Frankish-Alemannian populations diseases of the middle ear cleft significantly occur more frequently within the lower social groups. From this it is possible to deduce that external factors were paramount in the pathogenesis of these diseases in early cultures, whereas in the present mid-European populations constitutional factors predominate. In contrast to recent claims (Cockburn, 1977) that diseases of the middle ear were rare amongst inhabitants of the Americas before the arrival of Europeans, earlier literature and the observations presented in this article show that these diseases were not so uncommon. Cases found in ancient Peru show no evidence of surgical treatment, although the standards of surgery, which at that time included trephination, could have made this feasible.