Put a conch shell up to your ear and hear the ocean, but only if the external, middle and inner ears are all in working order. Cochlear implants only work for people with certain conditions. We don’t know for sure that a cochlear implant would have worked for Beethoven but his history does suggest that his hearing loss was due to a loss of outer hair cells and therefore would have responded to cochlear implants.

Last week, I was at the Chicago Symphony Orchestra enjoying a program of Lutosławski (Musique funèbre), Beethoven (Piano Concerto No. 3), and Tchaikovsky (Symphony No. 6 aka Pathétique), conducted by Christoph von Dohnányi. I was thinking about the fact that Beethoven was deaf and wondering whether too much music had been his undoing. It is not uncommon that peoples’ individual passion leads to a personalized form of biological cruelty, a disability that strikes right at a person’s ability to pursue their personal passion. Think overuse syndromes. Play the piano all the time and get focal dystonia in the hand; write or type for a living and get carpal tunnel syndrome; speak for a living and develop focal dystonia of the larynx. Could Beethoven’s deafness have stemmed from his being around music so much of the time?

The most common form of hearing loss is termed noise-induced hearing loss. This type of hearing loss depends on cumulative exposure to sound of moderate to high decibel levels. Because of the dependence on cumulative sound exposure, noise-induced hearing loss happens more and more frequently with increasing age. Back to Beethoven. I wondered if he could have lost his hearing because he was around musical sounds (assuredly not “noise” in the pejorative sense but noise in the physical sense) so much. So I looked up Beethoven on Wikipedia. I learned that the first signs of hearing loss occurred when Beethoven was only 26 years old. Too young for noise-induced hearing loss. And right around the age that Tom Rice was when he noticed that his hearing loss was impacting his life. As was true for Tom, Beethoven appeared to have suffered from symmetrical hearing loss; there are certainly no reports that one ear lost hearing before the other. Hmmmm. So, maybe Beethoven had a case of bad-luck-genetics, perhaps a spontaneous genetic mishap that was not inherited but sprang up de novo in him.

There are a number of speculative ideas about why Beethoven went deaf. These are interesting to a point but ultimately we are not likely to unequivocally resolve the cause of Beethoven’s hearing loss, almost 10 generations after he died (1770-1827). In any case, here, I want to address a different question. How did Beethoven’s hearing problems affect his composing and would Beethoven have benefited, as Tom Rice has, from a cochlear implant? Would his music have benefited?

Let’s start with a little information about Beethoven’s hearing loss. A number of web sites agree on the following general features and rough timeline:

• 1770 Beethoven is born
• 1796 first symptoms of tinnitus (buzzing sounds)
• 1799-1801 hearing loss begins with a loss of hearing at high frequencies followed by loss of hearing at progressively lower frequencies
• 1818 Beethoven had to rely on notebooks for understanding what people were saying to him. He apparently answered in spoken language because no written record of his answers has been discovered.
• 1824-25 Beethoven was reportedly deaf even to low frequency sounds

Beethoven wrote of his hearing loss in a frequently quoted letter written in 1801, “”I must confess that I lead a miserable life. For almost two years I have ceased to attend any social functions, just because I find it impossible to say to people: I am deaf. If I had any other profession, I might be able to cope with my infirmity; but in my profession it is a terrible handicap.” This quotation is taken from bio.com. Thus it appears that by 1800, Beethoven felt that he was deaf and that another 17 or so years later, he was unable to understand verbal language. By the 1820s, he was completely deaf.

The piece that I heard performed last week (Piano Concerto No. 3) was composed in 1800, when hearing was already a big problem for Beethoven. Of the 20 “composition highlights” listed by allmusic.com, only 2 were completed before 1800 (Piano Concerto No. 1 in C major; Piano Sonata No. 8 in C minor aka “Pathétique”). Edoardo Saccenti, Age K Smilde, and Wim H M Saris addressed the impact of Beethoven’s deafness on his music in a wonderful article in the British Medical Journal (2011;343:d7589). They analyzed string quartets that Beethoven wrote during his early (before hearing was a problem), middle (when his hearing was getting progressively worse), and late (when he was without any significant hearing) periods. They found that the proportion of notes that were high (at or above the G that is above high C, in the soprano range) was greatest early (~8%) and declined during the middle period to a low of <2% in compositions of 1810-11. In the late period, Beethoven’s use of high notes increased, to about 4%, greater than in the middle period but still less than the 8% of Beethoven’s early string quartets.

The short synopsis above does not do justice to the work by Saccenti and colleagues. It is worth reading the text, looking at the figures and listening to the video, all available through the above link. Well, kind of available. I can see the whole article through my university. But only a snippet is available to the general public. Arggh, the tribulations of moving toward open access but not being there yet… In any case, an account of the work by Saccenti and colleagues is publicly available at The Telegraph.

These data have been interpreted as evidence that when Beethoven could still hear, but poorly, he was hindered by his remaining hearing. The idea is that he was tied to physical sounds when he could hear but that when he became totally deaf, his compositions soared, free of constraints. When I started thinking about Beethoven and his deafness, I had the classic picture of a composer working with an ear to the piano, playing and listening, revising, playing and listening and on and on. But my friend and colleague Augusta Read Thomas, an internationally renowned composer, told me that she “hears everything in [her] inner ear/mind”. Beethoven reportedly did the same, even before he was forced by his disability to do so.  If losing his hearing did not deal a devastating blow to Beethoven’s composing abilities, it is hard to imagine that Beethoven could have been substantially helped by a cochlear implant. Of course, restoration of some auditory experience would have helped him in his everyday life but maybe not so much in his compositions.

Restoring a link to the auditory environment may even have hurt Beethoven’s art. Arthur Schopenhauer, a German philosopher of the first half of the 19th century, espoused a philosophy of aesthetics that extolled internal intellectual experience (“intellect”) over external events and the pressing needs that they engender (“will”). For Schopenhauer, music was the paragon of virtue as the highest possible artistic expression of intellect.

Energetic young street musicians playing outside the Paris opera house

Wagner was greatly influenced by Schopenhauer and also interpreted Beethoven through a Schopenhauerian lens. Through this perspective, deafness constrains an individual to the internal intellect, and frees that person from servitude to the auditory environment.

I am assuredly not doing justice to Schopenhauer’s ideas but even this butchering should serve our current purposes.

Thus we come back to the idea that a cochlear implant would have been neutral or perhaps harmful to the artistry of Beethoven’s musical compositions. Yet there is one more feature of Beethoven’s hearing loss to consider. Tinnitus (spontaneous sounds such as ringing in the ear) is one symptom that cochlear implants reliably help. Tinnitus was Beethoven’s first symptom (as well as Tom Rice’s).

Damage to neural pathways produce both negative signs and positive signs. Negative signs are those that are caused by the absence of function. Examples are blindness, deafness, and paralysis. Positive signs are those that are extra, somehow released by damage or disease. Examples are hallucinations, “paresthesias” such as spontaneous perceptions of pins and needles, tremor, and tinnitus. In general, positive signs are more common in sensory than in motor systems. Tinnitus that accompanies hearing loss is more the rule than the exception.

People with long-standing tinnitus generally “get used to it”. It does not go away but it is tolerated more facilely at year 5 than at day 5. Remarkably, just as tinnitus accompanies hearing loss, tinnitus tends to either get much better or disappear altogether after a cochlear implant. So let’s return to Beethoven. Certainly, Beethoven would have had an easier time in the world with a cochlear implant. But would his music have benefited in particular from a lessening of his tinnitus? We’ll never know of course. My hunch is that after years of living with the tinnitus, it was a bother but probably inconsequential to his musical compositions. And therefore, a cochlear implant would probably not have helped his music. It may have even brought him back to a more worldly plane, placing more mundane limits on his auditory imagination.

In closing, these musings are just that. There is no answer to be had but the journey sure is fun and interesting. And I am left wondering how environment influences artistic expression? Do minimalist surroundings encourage internal imagination and stimulating surroundings engender representations and externally grounded reactions? Can a single person switch modes by switching environments? Composing with and without ear plugs? This question is for all you artists, out there. Experience speaks volumes.