Beethoven’s Deafness

Neither the practice nor the science of medicine, nor for that matter medical history, would be perceptibly affected by the knowledge or ignorance of what caused Beethoven’s deafness. Nevertheless, the mystery of this retrospective diagnosis has held the interest of many investigators. The interest continues to the present day, as evidenced by the recent publication of two conflicting viewpoints on the subject within one month of each other.

Concurring with most otologists who have written about Beethoven’s deafness, Larkin1 favors the diagnosis of otosclerosis. The disease which started when the composer was 27 years old followed a characteristic pattern with severe tinnitus, early loss of higher frequencies, and gradual progression to complete loss of hearing in 15 years. Associated with this disability were frequent infections, colitis, rheumatism, splenomegaly, chronic pancreatitis and chronic hepatitis which progressed to liver failure and death. The conglomerate of these afflictions suggests, in Larkin’s opinion, a dysproteinemia or a connective-tissue disorder. On an entirely different tack, Naiken views Beethoven’s deafness in the context of Paget’s disease of bone. Favoring this hypothesis are the physical characteristics of the composer’s skull, face, and body; the combination of bone and nerve deafness; and the autopsy findings of a dense and thick skull vault, atrophy of the auditory nerves, and vascularity of the petrous portion of the temporal bones. Against this diagnosis is the early onset of the deafness, which is not typical for Paget’s disease. Neither Larkin nor Naiken accepts the older view, revived by McCabe, that Beethoven’s deafness was caused by syphilis. This view, we suspect, was responsible for much of the fascination evoked by the composer’s hearing loss. The stigma of venereal disease adds a piquant touch to tragedy. Incidentally, it also raises the question of the propriety of posthumous invasion of privacy. Disclosure of diagnosis, particularly that of a “social disease,” during the patient’s life would have been liable to legal and moral censure. Should such judgments terminate with the patient’s death? Read more...

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