Beethoven’s deafness more likely linked to viral infection than lead poisoning
Authors: Piotr Rzymski, Dorota Zarębska-Michaluk, Robert Flisiak
Journal: Journal of Infection (2023)

Dear Editor We thank Dr. Zichen Li and Dr. Leiliang Zhang for their interest in our review article "Could chronic HBV infection explain Beethoven's hearing loss? Implications for patients currently living with hepatitis B" 1Rzymski Piotr Zarębska-Michaluk Dorota Flisiak Robert Could chronic HBV infection explain Beethoven's hearing loss? Implications for patients currently living with hepatitis B.J Infect. 2023; 87: 171-176Abstract Full Text Full Text PDF Scopus (0) Google Scholar and for providing additional comments in their letter 2Li Zichen Zhang Leiliang Reconsidering the etiology of Beethoven's deafness: a cautionary perspective on chronic HBV infection.J Infect. 2023; https://doi.org/10.1016/j.jinf.2023.12.001Abstract Full Text Full Text PDF Google Scholar. Our work was prepared with the acknowledgment that the etiology of Ludwig van Beethoven's hearing issues, addressed over the years by various researchers, is unlikely to be fully elucidated due to insufficient clinical data. Nevertheless, when presenting our hypothesis that Beethoven's hearing loss resulted from HBV infection and discussing evidence supporting it, we primarily aimed to gain clinicians, including hepatologists, more awaraness to hearing issues that current patients with chronic hepatitis B may experience. In many cases, the exact etiology of hearing loss, including sudden sensorineural hearing loss (SNHL), is challenging to elucidate. However, it is well acknowledged that viral infection is a frequent cause of such events 3Cohen Brandon E. Durstenfeld Anne Roehm Pamela C. Viral causes of hearing loss: a review for hearing health professionals.Trends Hear. 2014; 18 (233121651454136)PubMed Google Scholar, 4Chen Xin Fu Yao-Yao Zhang Tian-Yu Role of viral infection in sudden hearing loss.J Int Med Res. 2019; 47: 2865-2872Crossref Scopus (63) Google Scholar. Moreover, we wish to stress that a hypothesis linking Beethoven's hearing loss to lead (Pb) intoxication, pointed out by Li and Zhang in their letter as the most probable, is no longer grounded in evidence. Initial, highly publicized observation of elevated Pb content in Beethoven's skull was not confirmed, while some osteologists excluded the possibility that the examined fragments belonged to the composer 5Barron James . Beethoven may not have died of lead poisoning, after all. NY Times 2010 .Google Scholar, 6Barron James . The mystery of Beethoven's skull remains unsolved. NY Times 2023 .Google Scholar. Similarly, the Hiller lock (allegedly cut from Beethoven's head the day he died), reported to contain elevated Pb content 7Reiter Christian Prohaska Thomas Beethoven's death-the result of medical malpractice?.Wien Med Wochenschr. 2021; 171: 356-362Crossref Scopus (7) Google Scholar, was recently molecularly evidenced to belong to a female, not Beethoven. Last but not least, a question arises: how would it be possible for Beethoven to be intoxicated with Pb to the extent of losing his hearing but to retain cognitive abilities (that Pb exposure is known to severely affect due to its neurotoxic action 8Ramírez Ortega Daniela González Esquivel Dinora F. Blanco Ayala Tonali Pineda Benjamín Gómez Manzo Saul Marcial Quino Jaime et al.Cognitive impairment induced by lead exposure during lifespan: Mechanisms of lead neurotoxicity.Toxics. 2021; 9: 23Crossref Scopus (55) Google Scholar) at the level allowing him to compose one of the greatest masterpieces ever written in music history, such as the Symphony No. 9? At the same time, a molecular analysis of Beethoven's authenticated hair sample provides compelling evidence that he was infected with HBV 9Begg Tristan James Alexander Schmidt Axel Kocher Arthur Larmuseau Maarten H.D. Runfeldt G.öran Maier Paul Andrew et al.Genomic analyses of hair from Ludwig van Beethoven.Curr Biol. 2023; 0https://doi.org/10.1016/j.cub.2023.02.041Abstract Full Text Full Text PDF Scopus (10) Google Scholar. As stressed by the authors of this analysis and our paper, the lack of viral DNA fragments in hair samples from earlier periods of Beethoven's life does not exclude an infection due to potential viremic fluctuations, likely affecting the deposition of genetic material in hair 1Rzymski Piotr Zarębska-Michaluk Dorota Flisiak Robert Could chronic HBV infection explain Beethoven's hearing loss? Implications for patients currently living with hepatitis B.J Infect. 2023; 87: 171-176Abstract Full Text Full Text PDF Scopus (0) Google Scholar, 9Begg Tristan James Alexander Schmidt Axel Kocher Arthur Larmuseau Maarten H.D. Runfeldt G.öran Maier Paul Andrew et al.Genomic analyses of hair from Ludwig van Beethoven.Curr Biol. 2023; 0https://doi.org/10.1016/j.cub.2023.02.041Abstract Full Text Full Text PDF Scopus (10) Google Scholar. Therefore, we stand against disregarding our hypothesis, consideration of which shall fuel further research on hearing issues in various populations of patients infected with HBV, especially since two large retrospective matched-cohort studies conducted in Asia already indicated the increased risk of SNHL in chronic hepatitis B 10Tsai Yao-Te Fang Ku-Hao Yang Yao-Hsu Lin Meng-Hung Chen Pau-Chung Tsai Ming-Shao et al.Risk of developing sudden sensorineural hearing loss in patients with hepatitis B virus infection: A population-based study.Ear Nose Throat J. 2018; 97: E19-E27Google Scholar, 11Chen Hsin-Chien Chung Chi-Hsiang Wang Chih-Hung Lin Jung-Chun Chang Wei-Kuo Lin Fu-Huang et al.Increased risk of sudden sensorineural hearing loss in patients with hepatitis virus infection.PLoS One. 2017; 12e0175266Google Scholar. This research received no external funding.