Everything We Know (And Don't) About Beethoven's Deafness

What We Know

Beethoven's hearing loss began when he was about 28 years old. For over a decade after that, the composer gradually lost his hearing. 

By the time he was in his forties, Beethoven was completely deaf. Historically, we know this because he wrote a letter in 1801 called the "Heiligenstadt Testament." 

In this letter, Beethoven wrote about his despair over his hearing loss and how it affected his life. Unable to communicate verbally, Beethoven relied on written notes to connect with his friends. 

After the premiere of one of Beethoven's most significant works—his 9th Symphony—received thunderous applause, Beethoven only noticed when he turned around to see the audience applauding.

What We Don't Know

There was, and still is, a lot of speculation about what caused Beethoven's hearing loss. 

As with most medical conditions, there can be influences from genetic and environmental factors. Unfortunately, at the time of his death, medicine was not as advanced as it is today, and there are limitations to what we can learn or understand about what led to Beethoven's hearing loss. 

There is a trail of breadcrumbs, though. So, fellow sleuths, it's time for us to don our detective hats and investigate.

Was it his environment?

Some historians believe his frequent exposure to loud music caused his hearing loss. 

We know that Beethoven spent a lot of time around music during his life. He played the viola, violin, piano, and organ. 

Each instrument can produce enough volume to damage hearing, especially over time. However, noise-induced hearing loss does not typically result in complete deafness; instead more typically results in a noise notch or high-frequency hearing loss. 

For example, patients with high-frequency hearing loss can often hear someone talking, but speech lacks clarity. This hearing loss differs from the complete deafness that Beethoven experienced by age 44.

There is also evidence that he suffered from lead poisoning, which could have contributed to his hearing loss. Lead is a toxin known to cause progressive hearing loss, among other symptoms. 

Beethoven did drink alcohol heavily, as evidenced by cirrhosis of his liver noted in his autopsy. And, wine at the time was often laced with lead (yes, really!). Could this have been the culprit? If not the leading cause, it certainly could have contributed. 

Still, other theories remain regarding what caused his hearing loss. For example, some believe that head trauma from falls contributed to his hearing loss. However, a labyrinthine concussion due to head trauma or skull fracture rarely becomes a progressive hearing loss. 

In my experience, most patients with this type of hearing loss (e.g., head injury following a car accident, TBI, a fall, etc.) experience a sudden change in hearing rather than progressive hearing loss. 

Was it his genes?

The next area to examine are any genetic contributions to Beethoven's deafness. Our scientific advances today have identified over 130 genes associated with hereditary hearing loss. Other syndromes or genetic conditions may also lead to hearing loss, such as Paget's disease. 

But, certain conditions, such as otosclerosis, run in families, yet we do not have identifiable genetic markers for this condition. So, could any of this apply to Beethoven? Let's examine the evidence.

One study examined locks of Beethoven's hair kept by relatives, a common practice at the time. Unfortunately, historical hair samples have limitations for testing and do not lend themselves well to testing for genetic hearing loss. 

Karl Rokitansky performed an autopsy on Beethoven after his death, which revealed atrophy on his auditory nerves, and his skull thickness was noted as dense and double the thickness of a normal skull. These findings fit with the theory that Beethoven had Paget's disease of the bone, which contributed to his hearing loss, as noted by the shriveled auditory nerves. 

Paget's disease interferes with the body's natural "recycling" process. To note, the average recycling process in the body causes old cells to be replaced with new cells over time. 

For someone with Paget's disease of the bone, old bone tissue is not recycled but remains in place as new bone tissue is added. This would explain why Beethoven had greater than average skull thickness and that this added bone tissue contributed to the atrophy observed in his auditory nerves. 

How did Beethoven have a music career with hearing loss?

When you consider the fact that musical geniuses such as Beethoven are a rarity themselves, it is all the more remarkable to think that he still composed masterful works without the ability to hear the music for himself. 

Despite hearing loss, Beethoven continued to create some of his most famous works, including his Ninth Symphony, which he composed when he was almost entirely deaf.

How could he do this? Most of us can imagine a song melody that we know. In Beethoven's mind, it's feasible that he could still "hear" melodies in his head and therefore imagine what they sound like. 

In other theories, he used bone conduction to hear the vibrations from instruments. However, Beethoven most likely had sensorineural hearing loss, and thus bone conduction would not have helped him to hear music better.