Hektoen International

A Journal of Medical Humanities

How did deafness affect the creativity of Ludwig Van Beethoven (1770–1827)?

Ting-Hsian (Denis) Chen 
Newcastle-under-Lyme, United Kingdom

 Ear trumpet for Beethoven. Illustration by author.


Ludwig van Beethoven (1770–1827) is one of the most revered composers in the history of Western music despite the onset of hearing loss early in his career.1,2 Beethoven’s works are traditionally categorized into three periods: early, middle, and late. Increasing deafness forced adaptation and eventually propelled Beethoven’s work from beautiful to sublime, mastering what Kant would understand as noumenon to overcome his illness and unshackle himself from subjectivity.

Early Period (1770–1801)

In his “Critique of Pure Reason,” Immanuel Kant (1724–1804) proposed the philosophy of transcendental idealism. Kant argued that the mental image created by looking at one object could be unique to every observer, so it is impossible to ascertain if two people’s perceptions of an object are the same. Thus, Kant believed in two worlds: the perceived world of phenomenon and the objective true world of noumenon, unobservable by subjective human perception.3 Beethoven perceived the phenomenal world with the accuracy of perfect pitch—the remarkable ability to produce notes without reference tones. Anton Schindler, an associate, claimed that Beethoven could even distinguish between notes very close in pitch through inflection differences.4

Beethoven absorbed the world of phenomenon, consistently achieving beauty in celebrated pieces like Sonata Pathétique (1798) and Moonlight Sonata (1801) by employing structures (French overture introductions and two-subject expositions) and techniques (incorporated E major chromatic features) used by earlier Viennese composers—Joseph Haydn (1732–1809) and Wolfgang Amadeus Mozart (1756–1791).5 Beethoven appreciated the musical paradigm of Vienna and mastered classical constraints of conventional instrumentation and symmetrical periodic phrasing, garnering numerous patrons from the Viennese aristocracy. Beethoven employed popular structures and techniques of the time such as French overture introductions and two-subject expositions and incorporated E major chromatic features. Sonata Pathétique was so popular that arrangements for string quartet, string quintet, wind nonet, and piano quartet were composed.2 Naturally, Beethoven had supreme confidence in his craft, gifting compositions as love letters and gratuity. Beethoven’s belief in his superior sound perception was evident as he lamented others playing his piece as “the poorest impression[s].”6

Middle Period (1802–1815)

Yet as time went on, Beethoven came to frequently document his tinnitus—a constant high-frequency ringing—and rheumatoid pain in letters. Both symptoms are associated with Paget’s disease of the bone, which may have caused his deafness. Paget’s is a condition characterized by the enlargement of individual bones in the body, commonly the pelvis, skull, and femur. When it affects temporal bones, the part of the skull housing the inner ear, and nerve supply associated with hearing, it often presents with progressive sensorineural hearing loss, starting from higher frequencies. Bone remodeling in Paget’s often obstructs the bony canal of Cocugno, which holds the inferior cochlear vein, causing pressure ischemia to the vestibulocochlear nerve. Dr. Stanley Oiseth, Phelps Memorial Hospital’s director of pathology, reviewed Dr. Johann Wagner’s autopsy of Beethoven and found that Beethoven had shrunken cochlear nerves—which transfer auditory signals to the brain—likewise consistent with this diagnosis.7 His skull had also doubled in thickness (1.3 cm) and increased in density, typical of Paget’s disease. Another diagnosis, lead poisoning, draws from the high lead levels found deep within Beethoven’s bones, indicating chronic exposure consistent with anecdotes of his drinking lead-laced wine.8

To mitigate his worsening hearing, Beethoven would place his ear against the piano and eventually saw off the legs of his piano, utilizing the floor as a massive soundboard. Johann Mälzel, the inventor of the metronome, created ear trumpets for Beethoven.9

Losing his trusted hearing was devastating. Deafness ended Beethoven’s concert career prematurely, leaving him to focus on composition. In a veiled suicide note, the Heiligenstadt Testament,8 Beethoven pleaded with his brothers to ensure he received a publicized autopsy, craving to give everyone a medical explanation for his “hostile, morose, and misanthropical” nature. Beethoven discusses losing his “passionate and excitable temperament…prone to the most tender feelings of affection” and drifting into despairing isolation due to the agonizing shame of asking others to “Speak louder!”:

Alas! how could I proclaim the deficiency of a sense which ought to have been more perfect with me than with other men,—a sense which I once possessed in the highest perfection. … So be it then! I joyfully hasten to meet Death…for his advent will release me from a state of endless suffering.

Comparing String Quartets Opus 74 and 95 to earlier Opus 18, Beethoven’s decreased usage of the upper register suggests the potential sensorineural loss of higher frequencies.10 It is possible Beethoven’s worsening ability to perceive the phenomenal world limited the music he composed.

Late Period (1816–1827)

Both Kant and Arthur Schopenhauer (1788–1860) drew a strong distinction between the beautiful and the sublime.4,11 Kant believed that for art to be sublime, its physically overwhelming phenomena must be overcome through contemplation. For instance, our minds can perceive the concept of a severe storm while viewing a painting of one, considering the harm and destruction it can deal whilst not being affected by its power. Hence, we regain tranquil control and establish our superiority over the phenomena, thereby achieving the feeling of sublime.3 Schopenhauer added that achieving the contemplative sublime state requires struggle in contrast to beauty.12 He believed that sublime is only achieved when contemplation of a threatening concept leads to pure objectivity, reaching the true noumenal world of concepts, “the world as will,” uninhibited by subjective human perception.11,12

By 1816, Beethoven was completely deaf; in 1824, he composed Symphony No. 9, considered by many to be the greatest work in Western music history.13 With no perception of sound, Beethoven was cut off from the world of appearances, freed from influence and his own subjective perceptions, composing purely from the noumenal world of concepts. Truly uninfluenced, Beethoven mobilized the entire register once again and radically introduced the human voice to a symphony for the first time in history. He became a master of the noumenal world.

There was no perception, just contemplation. Beethoven could not hear a single note; in frightening emptiness, he imagined notes, harmonies, and melodies, and directly from that noumenal world produced internal art depicting the purest concepts of true joy and triumph, unadulterated by his own subjective perception of how such concepts should sound or be presented. Beethoven’s music is therefore truth, the world as will, only altered by the audience’s perception.

Beethoven stepped back on the stage at its premiere, with the orchestra instructed to instead follow conductor Michael Umlauf, hidden under the stage. The grandiose first movement introduces sweeping brass and metal, followed by a second movement of excruciating struggle; then, for the first time, an unapologetic voice enters in the third movement. After three full movements of struggle, Beethoven produced a final, triumphant movement of joy. Symphony No. 9 was a colossal exercise of the mind, testing Beethoven’s true understanding of music over his perception of it, establishing the highest superiority over his illness and overwhelming desire for relief from his suffering.14

From the noumenal world, truth—of struggle and triumph—depicted in Symphony No. 9 is objective and, therefore, universal.15 The drama and joy within Symphony No. 9 crosses social and political boundaries, from the European Union’s anthem to the Tiananmen Square and Berlin Wall protests.16 Hence, from arguably unanimous critical praise since the first performance of Symphony No. 9 to now, the genius of Beethoven’s late work can be ascertained.


Hearing loss shattered Beethoven’s connection to the phenomenal world and plunged him into long-standing fear. Yet, Beethoven conquered his disability and fear through the production of sublime art. Beethoven’s deafness forced him to become a master of the noumenal world, communicating truth that resonates across cultural boundaries, a truth untampered by perception.


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  2. Whipple, Weldon L. Beethoven’s Organ Works: A Study. Wellspring Music, 2016.
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  4. Papadimitriou, Dimitri. An Exploration of the Key Characteristics in Beethoven’s Piano Sonatas and Selected Instrumental Repertoire. 2013. Royal Irish Academy of Music, PhD thesis. Trinity’s Access to Research Archive, http://www.tara.tcd.ie/handle/2262/76026.
  5. Bilson, Malcolm. The Emergence of the Fantasy-Style in the Beethoven Piano Sonatas of the Early and Middle Periods.University of Illinois at Urbana-Champaign, 1968.
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  11. Shapshay, Sandra. “Schopenhauer’s Aesthetics”. Stanford Encyclopedia of Philosophy, Stanford University, 2012.
  12. Vasalou, Sophia. Schopenhauer and the Aesthetic Standpoint: Philosophy as a Practice of the Sublime. Cambridge University Press, 2013. doi:10.1017/CBO9781139169240.
  13. Stevens KM, Hemenway WG. Beethoven’s Deafness. JAMA. vol 213, 1970, pp. 434–437. doi:10.1001/jama.1970.03170290030006
  14. Cook, Nicholas. Beethoven : Symphony No. 9. Cambridge: Cambridge University Press, 2008
  15. Young, Julian. “Death and Transfiguration: Kant, Schopenhauer and Heidegger on the Sublime.” Inquiry 48, no. 2, 2005, pp. 131–44. https://doi.org/10.1080/00201750510022736.
  16. Rehding, Alexander. Beethoven’s Symphony No. 9. Oxford University Press, 2018.

DENIS CHEN is a Taiwanese medical student at Keele University, United Kingdom. Denis started playing the violin at the age of three and always had a fascination with medical humanities. Denis wanted to investigate the effects of Beethoven’s disability on his art and, more specifically, understand why Beethoven’s 9th Symphony became so universally popular. 

Winter 2024



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