For more than 5,300 years, it lay undisturbed beneath a Stone Age tomb in northern Spain, hidden among the remains of nearly 100 people. When archaeologists finally uncovered the ancient skull, they expected another glimpse into prehistoric life. Instead, they found evidence of something far more extraordinary. Careful examination revealed that the woman had undergone not one but two complex ear surgeries thousands of years before modern medicine existed. Even more astonishing, signs of new bone growth showed she survived both procedures, making the discovery the world’s earliest known physical evidence of ear surgery and rewriting what scientists know about prehistoric healthcare.The skull was unearthed in 2018 from the Dolmen of El Pendón, a large Neolithic burial monument near Reinoso in Spain’s Burgos province. The tomb, which dates back to between 3800 BCE and 3000 BCE, served as a collective burial site for around 100 individuals. Among them was the skull of an elderly woman, believed to have been around 65 years old, whose remains would become the focus of an extraordinary scientific investigation.
How the 5,300-year-old skull revealed the world’s earliest ear surgery
Researchers found two carefully made openings behind the woman’s ears, indicating she had undergone two separate surgical procedures. One operation was performed on the right side of her skull, while the other targeted the left. Scientists believe the surgeries may have taken place months or even years apart. The precision of the cuts ruled out accidental injury or ritual modification, pointing instead to deliberate medical treatment.According to the study published in Scientific Reports, the woman most likely suffered from mastoiditis, a dangerous bacterial infection affecting the mastoid bone behind the ear. If left untreated, the condition can spread to the brain, causing meningitis, blood clots or even death. Researchers believe prehistoric healers identified the source of the infection and removed the diseased bone in an attempt to save her life.The most convincing evidence that the procedures were successful came from the skull itself. New bone had formed around both surgical openings, proving the woman survived for at least several weeks after each operation and possibly much longer. Without this bone regeneration, archaeologists may have dismissed the openings as damage caused after death rather than evidence of surgery.
Stone Age surgeons relied on flint tools instead of modern medicine
Unlike modern operations carried out with surgical drills and anaesthesia, the prehistoric procedure was performed using sharpened flint tools. Researchers believe the surgeon gradually scraped and drilled through the mastoid bone using slow, circular movements until reaching the infected area. Microscopic analysis of the skull revealed cut marks consistent with stone tools, suggesting the operation required considerable skill, precision and anatomical knowledge.Archaeologists also recovered a flint blade from the burial site that showed microscopic signs of cutting bone. The tool had been heated repeatedly to around 350 degrees Celsius, leading researchers to suggest it may have been sterilised or used to cauterise tissue during the procedure. Although its exact purpose cannot be confirmed, the blade offers a rare glimpse into the medical practices of Neolithic communities.
The surgery would have been incredibly painful
The operation took place thousands of years before antibiotics, anaesthesia or metal surgical instruments existed. Researchers believe the woman may have been physically restrained during the procedure or given naturally occurring pain-relieving plants such as poppy or other psychoactive herbs to ease her suffering. Despite the intense pain and the constant risk of infection, she survived both operations, highlighting the surprising effectiveness of the treatment and the expertise of the prehistoric healer.Before this discovery, the earliest physical evidence of mastoid surgery dated to the Proto-Byzantine period between the fourth and ninth centuries CE, while the first written descriptions of the procedure did not appear until the 17th century. The Spanish skull pushes direct archaeological evidence of ear surgery back by more than 4,000 years, making it the oldest known example ever discovered.
What the discovery tells us about prehistoric medicine
The discovery challenges the long-held belief that Stone Age societies relied only on primitive remedies. Instead, it suggests they were capable of diagnosing serious illnesses, identifying their source and carrying out complex surgical procedures that gave patients a genuine chance of survival. Together with other archaeological evidence of trepanation, early amputations and ancient dental treatments, the Spanish skull paints a picture of prehistoric communities that possessed far more advanced medical knowledge than previously believed.