Particulate air pollution—smoke, chemicals, pollens, molds, animal waste, sand, and other particles—is a serious health issue today, causing irritation and inflammation of the respiratory tract, directly resulting in respiratory conditions such as maxillary sinusitis and increased susceptibility to infectious diseases. This chapter explores bony changes within the maxillary sinuses and their association with upper respiratory tract disease, environmental air quality, and possible exposure to particulate pollution in the past. The Middle Nile Valley has undergone progressive aridification over the last 5000 years, with an increase in airborne particles such as dust and sand. We examined 427 skeletons from 12 sites in the Middle Nile Valley, dating 4900 BC to 1500 AD. There was a significant increase over time from 32.5% in the Neolithic period (c. 4900–4300 BC) to over 50% prevalence after 2500 BC. The highest prevalence (82.4%) was observed in the Medieval urban center of Soba East (c. AD 550–1500). Human health is always a complex interplay of factors and the extremely high prevalence at Soba East points to combined impacts from aridification and declining air quality, as well as changing occupational activities, ventilation requirements, increased population density, socio-sanitation issues, and infectious respiratory disease-load. Although we often think of poor air quality as a modern phenomenon, analysis of archaeologically derived skeletons suggests a deep-time association between air quality and respiratory disease in human populations. Aridification and poor air quality are an increasingly important challenge of global warming; this research points to their longstanding impacts on human societies.