A 5,300-year-old skull from Spain has revealed what might be the world’s oldest example of ear surgery. Excavations in Reinoso, northern Spain, unearthed the skull as part of a mass grave of more than a hundred individuals who suffered from a variety of pathologies. The skull had been perforated multiple times, presumably to relieve the pain and pressure of an ear infection, and—given that the woman lived after the surgical interventions—is, thus, the earliest example of a successful ear surgery.

The skull was found in an ossuary as part of the excavation of a fourth millennium B.C. megalithic monument conducted by the University of Valladolid. The team published their findings in the journal Scientific Reports. The woman’s skull showed evidence of surgical intervention via trepanation in both of her ears. The procedure was first performed on her right ear before a subsequent procedure on her left was undertaken. Seven cut marks at the edge of the surgical site in the left ear confirm that the holes in her skull were the result of surgical intervention (a mastoidectomy) rather than accidental trauma or deliberate injury. That the bones in her right ear had healed is a sign that she survived the procedure.

Manuel Rojo Guerra, one of the lead researchers on the project, said that it “must have been carried out by specialists or individuals with certain anatomical knowledge and accumulated therapeutic experiences.” Having eliminated other potential diagnoses, including tumors, the scientific team that studied the skull concluded that she likely suffered from a painful middle ear infection that caused excruciating pain and fevers. Without treatment, fluid buildup behind the eardrum can lead to hearing loss and even a life-threatening inflammation.

ÑFotógrafos Photography Study/Scientific Reports

The surgery was not for the faint-hearted. The woman, who scientists estimate was 35 to 50 years old, would have had to have been restrained and held in place during the procedure. It’s possible, though not provable, that some kind of plant-based sedation was administered in advance. The surgery itself would have been extremely painful and (given the age of the site in which the skull was discovered) would have been performed using a stone implement that was almost certainly made of flint.

Though surgical procedures to relieve pressure and fluid buildup are now common and relatively risk free, they only became widespread in the late 19th century. Prior to that the first documented description of the procedure comes from famous French 16th century physician Ambroise Paré. He apparently recommended the treatment to the French king François II in 1560, but François’s mother Catherine de Medici forbade it. François eventually died of an ear infection but that was hardly Paré’s fault. As a result, the credit for the first successful mastoidectomy went to the French surgeon Jean-Louis Petit. By the 20th century, and even before the advent of widespread antibiotic use, the procedure was common. San Francisco surgeon Francis Sooy reported that until 1940 he regularly saw patients in the morning, before popping across the street to his surgery to drain some ear abscesses in the afternoon.

There are good reasons to think that ear surgery started much earlier. Images of barber surgeons casually operating on the ear date to the early 16th century, but the real pioneer was the Greek-speaking second-century physician Galen of Pergamum. Galen, who recognized the general benefit of draining abscesses, may hint at this procedure in his writings, but there is considerable debate about whether or not he ever performed the surgery himself.

Even without surgery there were numerous ingestible ancient remedies for ear trouble. Galen prescribed honey for ear pain. As seasonal allergies can cause ear discomfort and some claim this can be alleviated by ingesting local honey, it’s possible (though unlikely) that some patients may actually have benefitted from this treatment. A less appetizing treatment for ear pain, also attributed to Galen, was to boil dung beetles in olive oil and drip the resulting concoction into the affected ear. This treatment is noteworthy given that beetles are known to sometimes invade the ear—and the rectum, but that’s a whole other story—with undesirable results. Close your screen doors at night, people.

Like so much ancient medicine, many of remedies would have been devised and administered in the home by women. As Laura Zucconi notes in her History of Ancient Medicine, the most noted female healer in the Talmud, the stepmother of Rabbi Abaye, reportedly had effective cures for heart problems, fevers, scorpion bites, and ear infections. Whether any of these treatments were effective is a whole other story, while eye surgery (especially cataract surgery) is well documented in antiquity, ear infections are near impossible to treat without antibiotics.

In the case of the 5300-year-old woman survived at least her first procedure, proving that there were some sophisticated and technically adept medical practitioners in fourth millennium B.C. Spain. Whether she consented to treatment is a whole other question to which we will never know the answer. She does seem to have fared at least as well as her burial companions, whose myriad injuries and pathologies have yet to be fully studied.

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