In Reference to Beethoven's Deafness.

Abstract

Dear Editor: There have been many theories proposed to explain the deafness of Ludwig van Beethoven. One reason is because his history is complex. Brotto supports the theory by Stevens by presenting a progressive hearing loss in a living person where lead poisoning was found to be the cause. In this illuminating patient, lead came from a pan with a worn ceramic surface with which the patient used to cook her food for many years. Although lead poisoning has been considered previously, it has been dismissed because wrist drop, a common finding in lead poisoning, was not found in Beethoven. Brottosuggests that lead poisoning causes a variety of symptoms that, depending on the time of exposure and healthcare support, are extremely variable from person to person. However, Reubens indicates there is another explanation for Beethoven’s lack of wrist drop. Chronic low-level lead exposure results in sensory and autonomic rather than motor neuropathy. This is due to an alternate mechanism of metabolism than that found in high levels of acute lead exposure. Brotto substantiates Beethoven’s alcohol dependence problem and further confirms that the most likely cause of Beethoven’s deafness was his consumption of wine tainted with lead. Beethoven particularly liked inexpensive Hungarian wine to which lead had been added to improve the flavor. We therefore congratulate the authors on what is not an obscure diagnosis, but what is the most likely to be correct. Although we do not have the advantage of audiograms and blood lead levels, Beethoven did have high levels of lead in his hair and deep in the bone. The latter indicates a history of lead exposure recurring over a period of many years. Michael H. Stevens, MD Emeritus Professor of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.