Abstract
There have been many theories proposed to explain the deafness of Ludwig van Beethoven, because his history is complex. Evidence of otosclerosis is lacking, because close gross examination of Beethoven’s middle ear at autopsy did not find any otosclerotic foci. His slowly progressive hearing loss over a period of years differs from the reported cases of autoimmune hearing loss, which is rapidly progressive over a period of months. The absence of mercury in Beethoven’s hair and bone samples leads us to conclude that his deafness was not due to syphilis, because in that era, syphilis was treated with mercury. Microscopic examination of bone samples and examination of the middle ear have found no evidence of Paget’s Disease. High levels of lead found deep in the bone suggest repeated exposure over a long period of time. The finding of shrunken cochlear nerves at his autopsy is consistent with axonal degeneration due to heavy metals such as lead. Chronic low-level exposure, like Beethoven’s, causes sensory and autonomic findings rather than the classic wrist drop due to motor neuropathy. Beethoven’s physicians thought that he had alcohol dependence. He particularly liked wine to which lead had been added to improve the flavor. A live patient reported in 2021 from Italy with a slowly progressive hearing loss and other symptoms like Beethoven had, was found to have lead poisoning. Therefore, the most likely cause of Beethoven’s deafness was his consumption of wine tainted with lead.