Christmas 2011: Diagnosis

Beethoven’s deafness and his three styles

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7589 (Published 20 December 2011)
Cite this as: BMJ 2011;343:d7589

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Please see: Beethoven’s deafness and his three styles

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  1. Edoardo Saccenti, postdoctoral research fellow12,
  2. Age K Smilde, full professor12,
  3. Wim H M Saris, full professor23
  1. 1Biosystems Data Analysis Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Science Park 904, 1098 XH, Amsterdam, Netherlands
  2. 2Netherlands Metabolomics Centre, Einsteinweg 55, 2333 CC, Leiden, Netherlands
  3. 3Department of Human Biology, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER, Maastricht, Netherlands
  1. Correspondence to: E Saccenti e.saccenti{at}uva.nl

Edoardo Saccenti and colleagues chart the relation between the composer’s deafness and his compositions

Beethoven’s deafness

Beethoven (1770-1827) first mentioned his hearing loss in a letter to the physician Franz Wegeler dated 29 June 1801:

“For the last three years my hearing has grown steadily weaker . . . I can give you some idea of this peculiar deafness when I must tell you that in the theatre I have to get very close to the orchestra to understand the performers, and that from a distance I do not hear the high notes of the instruments and the singers’ voices. . . Sometimes too I hardly hear people who speak softly. The sound I can hear it is true, but not the words. And yet if anyone shouts I can’t bear it.”

Some details of Beethoven’s hearing loss can be derived from accounts found in his correspondence (table). His left ear was affected first, and he reported (bilateral) tinnitus, high tone hearing loss associated with poor speech discrimination, and recruitment with loud noises. Czerny reports that after 1812 people had to shout to make themselves understood.1 In 1818 Beethoven started to communicate through notebooks. There are no reports that he could still understand spoken conversation after 1825, so we assume that his deafness was almost complete by then.2 Although still debated, these symptoms suggest a sensorineural hearing loss with its origin in the organ of Corti.3 Wagner and Rokitansky (the father of modern morbid anatomy) performed a postmortem examination on 27 March 1827, the day after the composer’s death,4 and wrote:

“The Eustachian tube [and] the facial nerves were very much thickened. The acoustic nerves on the other hand were wrinkled and were without a medulla. The auditory arteries running near them were dilated beyond the size …

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