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What We Know, What We Can Only Guess
Hearing loss sneaks up on you. Its first symptoms are often subtle and easily explained away — especially if you're a musician who takes pride in the acuity of your hearing. "Having a good ear" is a familiar metaphor for having musical talent. If one day a friend's speech is a bit difficult to understand, or a sound heard by someone else fails to register, it is easy and tempting to blame it on something other than deafness. Yet the fact is that musicians are more prone to lose their hearing than most other people. Hours spent practicing in small rooms or playing with large ensembles can take their toll, and it is not unusual for an experienced musician to begin to suspect that his or her ears aren't as good as they used to be. The high rate of hearing loss among musicians, classical as well as popular, is a well-kept professional secret, because denial of the condition starts with musicians themselves. Many simply don't want to admit they have a problem.
One can only imagine, therefore, how early Ludwig van Beethoven began to notice that his ears were betraying him. What we do know is when he found it impossible to remain in denial. On June 29, 1801, the thirty-year-old composer wrote a letter to an old friend from Bonn, Dr. Franz Wegeler, which is often cited but nevertheless worth quoting at length. After a short summary of his present circumstances, Beethoven wrote that despite his professional success, "that jealous demon, my poor health, has played a nasty trick on me. To wit, for three years my hearing has become steadily weaker. This supposedly stems from my lower abdomen, which, as you know, has long given me distress, but has grown worse here." A local doctor had prescribed treatments both for the intestinal symptoms he described and for his ears, and while the former had been successful,
my ears continue to ring and hiss day and night. I must say that I lead a wretched life. For two years I have avoided nearly all company, since it is impossible for me to tell people that I am deaf. ... To give you an idea of this strange deafness, let me tell you that at the theater I must lean in very near to the orchestra in order to understand the actor. If I am some distance away, I do not hear the higher notes of instruments and voices. I am surprised that there are people who have never noticed it in conversation; since I am often distracted, they attribute it to that. Much of the time I can hardly hear someone who speaks quietly — the sounds perhaps, but not the words — but as soon as someone shouts I find it unbearable.
Beethoven went on to say that one of his doctors had assured him that his hearing would get better, although it would never be fully restored.
One thing that is clear from this letter is that physicians of Beethoven's time — presumably including Wegeler, to whom he described his symptoms in detail — had little understanding of the causes and treatment of hearing loss. Neither they nor the composer seems to have questioned the assumption that his growing deafness was connected to his long-standing digestive symptoms. One doctor treated his ears with almond oil, while another prescribed baths in the Danube for both conditions. Not surprisingly, neither treatment helped him to hear better.
With the benefit of hindsight, it is also evident that Beethoven had at least two symptoms widely associated with sensorineural hearing loss, one of the two major types of deafness recognized by today's doctors. Unlike conductive hearing loss, which results when sounds are blocked from reaching the inner ear, sensorineural hearing loss stems from malfunctions in the inner ear itself, where the sense of hearing is centered, or in the nerves that transmit its signals to the brain. The symptoms Beethoven experienced reflect not just an absence of sound but distortions in the way he perceived it: tinnitus ("ringing in the ears") is an annoying, often maddening auditory illusion characterized by persistent sounds that seem to originate inside the victim's head; the unbearably loud shouting, or "loudness recruitment," occurs when the brain compensates for a loss of auditory information at low volumes by registering sounds of greater intensity as being louder than they actually are. If Beethoven began to notice these symptoms at twenty-seven, it is likely that the process that produced them began even earlier.
What caused these symptoms to develop in a man in his mid-twenties? We may never know for sure, because Beethoven's temporal bones, including the bones of the inner ears, were removed during his autopsy and have since disappeared. Still, we can make some reasoned speculations. Deafness from sensorineural causes can manifest suddenly and with no warning, but it can also develop gradually, either as a result of aging or due to external causes. Excessive exposure to loud sounds often plays a major role, but viral infections can contribute as well, as can circulatory problems that interfere with the supply of blood to the inner ear.
In Beethoven's case, two possible explanations have been advanced for the onset of his condition. He is said to have become seriously sick during the summer of 1796; the illness, according to one source, "settled in his organs of hearing, and from this time on his deafness steadily increased." While the fact of such an illness is accepted by Beethoven's most celebrated biographer, its exact date and nature are unknown. Beethoven is also said to have had an episode of typhoid fever during his youth, which could possibly have resulted in nerve damage.
Beethoven himself is said to have suggested a different explanation to his English friend Charles Neate. As a young man, he said, he was working on an opera (not Fidelio) and had to deal with a very difficult tenor: hearing a knock at his door, he reportedly said, "I sprang up from my table under such an excitement of rage that, as the man entered the room, I threw myself upon the floor as they do upon the stage, coming down upon my hands. When I arose I found myself deaf and have been so ever since. The physicians say the nerve is injured." This account is suspicious for several reasons; it is reported thirdhand and well after the event, and the statement that Beethoven was deaf from that point forward is inconsistent with accounts of a gradual hearing loss. It should be noted, though, that while Fidelio was Beethoven's only complete opera, he probably wrote a tenor solo for Ignaz Umlauf's Die schöne Schusterin in or around 1796, which is the same year he later claimed his deafness began. The author of an essay on Beethoven's medical history notes that "this would describe an attack of vertigo, 'labyrinthine apoplexy,' from interference with the blood supply to or bleeding in the auditory region." This is also the only time Beethoven is said to have reported symptoms resembling the dizziness that is frequently associated with inner-ear disease; as the same author points out, the reflexive "threw myself" canbe understood as a passive construction and doesn't mean that the fall was deliberate.
By documentary standards, neither of these stories is satisfactory, and they could easily be dismissed as mere rumor or speculation. It is certainly possible, though, that Beethoven suffered the beginning of hearing loss around 1796 due either to a recent or past physical illness or to a vascular episode in which his inner ears were temporarily deprived of blood. These are now, and were then, among the most common causes of sensorineural deafness.
As I have already noted, there is an entirely different category of hearing loss that results from conductivity problems inside the ear. These may also result from infection, or even from a simple accumulation of earwax. Conductive hearing loss, though, may also be caused by otosclerosis, or abnormal growth of the bones that lie in the middle ear between the eardrum and the cochlea. These include the ossicles, or "little bones": the malleus, the incus, and the stapes, also known as the hammer, the anvil, and the stirrup. If these lose their flexibility and cannot move, sound vibrations cannot travel past the eardrum. Otosclerosis is a hereditary condition, and the fact that nobody else in Beethoven's family is reported to have suffered from it makes this diagnosis problematic. However, it may also be activated by viral infections, including common diseases like measles that Beethoven might well have experienced. (Though Beethoven bore on his face the scars of smallpox, measles was so commonplace that it was unlikely to have been mentioned in the historical record.) In simple conductive hearing loss, the auditory nerves, including the hair cells in the cochlea, are not affected; rather, external sounds are blocked before they can reach them.
It has long been suggested that the nature and progress of Beethoven's deafness, along with the time in his life when his symptoms began to appear, are consistent with a diagnosis of cochlear otosclerosis, which straddles the two categories. In this condition, hardening takes place in the cochlear endosteum: the connective tissue between the stapes and the cochlea. In many cases this leads to fixation of the stapes; the stirrup, the closest bone to the inner ear, becomes immobile, so vibrations cannot be transmitted to the cochlea. Even when this fixation does not occur, cochlear otosclerosis is often associated with damage to the hair cells of the cochlea and the auditory nerve, which connects the inner ear with the brain, resulting in sensorineural hearing loss. Whether Beethoven's stapes were fixed in this manner may never be known, since the doctor who performed his autopsy did not comment. The autopsy did confirm damage to his auditory nerves, however. Taken in connection with Beethoven's observed symptoms, this establishes beyond a reasonable doubt that his deafness was at least in part sensorineural. The most common hypothesis is that his stapes were also fixed, resulting in mixed sensorineural and conductive hearing loss. Such a diagnosis would be consistent with all the symptoms Beethoven and others reported, and cochlear otosclerosis is a likely cause. This might have been triggered by one of Beethoven's numerous illnesses, and it does not rule out the possibility of labyrinthine apoplexy or other contributing factors.
Needless to say, with a case as famous as Beethoven's a provisional diagnosis like this is subject to challenge, and many other hypotheses have also been put forth. A series of writers from Romain Rolland through Maynard Solomon have argued that Beethoven's deafness was at least to some extent self-inflicted; Rolland blamed it on the "furious concentration" that characterized Beethoven's genius, whose effects he compared to those of yogic meditation, and Solomon suggested that it fulfilled a psychological need. Beethoven's deafness has been blamed on syphilis, although there is no proof he had the disease. It has been blamed on alcoholism, although there is no proof he was an alcoholic and no obvious reason this would have caused him to become deaf. Most recently, there was a flurry of attention to claims that Beethoven suffered from plumbism, or lead poisoning, caused either by medical malpractice during his final illness or by a lifelong habit of drinking cheap wine. There actually is a possibility that an inflammation of the bowel could also damage the ears, but the symptoms of such an inflammation do not seem to match those that Beethoven reported. Nevertheless, an argument has been made that autoimmune bowel disease is the most persuasive explanation for Beethoven's deafness. He certainly suffered from severe intestinal problems throughout his adult life, so it is at least worth considering that his two most notable health problems were in some way related.
While Beethoven's hearing loss is often described as gradual and inexorable, it appears likely that for more than ten years after the letter to Wegeler there was actually little change. In 1802 Beethoven's friends began noticing his deafness, although they may well have suspected it earlier and kept it to themselves. The first written description is provided by Ferdinand Ries, and it is searing in its directness. He and Beethoven were walking in the fields around Heiligenstadt, a country town outside Vienna where Beethoven's doctor had sent him to rest his hearing, and where the Heiligenstadt Testament would be written a few months later: the document in which he poured out his heart to his brothers about his increasing emotional distress. Hearing a shepherd playing on a wooden flute, Ries remarked on it to Beethoven, who was forced to admit that he heard nothing. The ruse could no longer be maintained. There is another version of this story, though, also from Ries, that describes a similar incident a few years later. Since Beethoven alludes to the flute incident in the Heiligenstadt Testament, the earlier story is probably true, but the later one suggests that little changed in the ensuing years; he could still pretend he was fooling people until directly confronted with evidence to the contrary.
In 1804, when he was thirty-three years old, Beethoven is said to have had trouble hearing the wind instruments when the full orchestra was playing at rehearsals for the recently completed Eroica Symphony, but the letter to Wegeler ("if I am some distance away I do not hear the higher notes of instruments and voices") suggests that this would have been true three years earlier as well. In 1808, at the nearly interminable concert at which both the Fifth and Sixth Symphonies were premiered, Beethoven stopped the orchestra in the middle of his Fantasy for Piano, Chorus, and Orchestra, op. 80, because of a breakdown in the orchestral accompaniment. This occurred at a point at which only two oboes are supposed to be playing with the piano, and according to an eyewitness account the clarinets entered at the same time, sixteen measures early. Beethoven tried to stop the clarinets and apparently succeeded, but was so dissatisfied that he forced the orchestra to start again from the beginning. Since only a few instruments were playing, this account does not contradict the report from 1804. The oboe and clarinet parts in question, though, are harmonically fairly similar, and Beethoven could have let the mistake pass. The fact that it disturbed him enough to cause him to stop a performance in progress shows that his hearing of live music was still suprisingly accurate.
Perhaps more significantly, early the next year he sent some minor corrections to his publisher Breitkopf und Härtel based on having heard the symphonies in performance. "When I gave them to you," he wrote, "I had not yet heard any part of them, and one must not try to be so godlike as not to try to improve anything here and there in one's creations." The primary musical change comes at the beginning of the second movement of the Pastoral Symphony, the "Scene by the Brook," and it is subtle but significant. The movement opens with a fragmentary melody in the first violins backed up by a rocking accompaniment in 12/8 meter by the second violins, violas, and cellos, all playing with mutes. The manuscript divides the entire cello section into two groups, indicated by the fact that Beethoven wrote two separate parts on a single staff. In the second letter to his publisher, Beethoven specified that these parts should be played by two solo cellos and that the rest of the cellos should play with the basses, as was often the case in orchestral music at the time. This change required a sophisticated judgment about the sonic balance of an ensemble that at times has up to six distinct harmonic parts, and Beethoven apparently made it either after hearing the music performed or, more likely, during rehearsal.
Until at least 1812 Beethoven also carried on conversations successfully enough to have an active, if limited, social life and several love affairs; the ear trumpets and conversation books came later. Thus while his hearing does appear to have deteriorated quickly during the 1810s, for a dozen or so years before that he was hardly the deaf musician of popular conception. In May 1809 he was so distressed by the noise of Napoleon's bombardment of Vienna that he buried his head in pillows in the cellar of his brother Caspar Carl's house. This suggests that his loudness recruitment was still active enough to produce acute discomfort — the same kind of discomfort that he reported to Wegeler in 1801 when people spoke too loudly.
A letter written to Wegeler on May 2, 1810, is revealing. Beethoven said that he would be happy, "perhaps one of the happiest of people, if the demon had not taken up residence in my ears. If I had not read somewhere that one should not willingly depart from this life as long as he can accomplish something worthwhile, I would be long gone, and by my own hand. Life is so beautiful, but for me it is poisoned forever." Reading this, it is natural to assume that Beethoven is referring to his deafness. The wording, though, is actively affirmative — "wenn nicht der Dämon in meinen Ohren seinen Aufenthalt aufgeschlagen" — suggesting a malicious presence rather than an absence. It is possible that the demon in his ears was not deafness but tinnitus; despite its popular description as "ringing in the ears," this affliction can in fact be so devastatingly loud as to drive a person near madness. As we have seen, Beethoven complained about this already in 1801.(Continues…)
Excerpted from "Hearing Beethoven"
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Table of Contents
Introduction: A Road Trip to Texas 1
1 Beethoven's Deafness: What We Know, What We Can Only Guess 11
2 2003: A Sudden Case of Deafness 37
3 The Deaf Composer 59
4 Deafness, Vocation, Vision 77
5 The Artifacts of Deafness 109
6 Ears, Eyes, and Mind 151
7 Hearing through the Eyes 177
Epilogue: Embracing Wholeness 211