Lead and the deafness of Ludwig van Beethoven

Could chronic HBV infection explain Beethoven's hearing loss? Implications for patients currently living with hepatitis B

The cause of Ludwig van Beethoven's health deterioration, i.e., hearing loss and cirrhosis, have been subject to various studies. The genomic analysis of his hair indicates infection with the hepatitis B virus (HBV) at least 6 months prior to death. However, considering his first documented case of jaundice in the summer of 1821, second jaundice months prior to his death, and increased risk of hearing loss in HBV-infected patients, we offer an alternative hypothesis of chronic HBV infection as a cause of deafness and cirrhosis. According to it, HBV was acquired early, progressed from immune-tolerant to an immune-reactive phase, and triggered Beethoven's hearing issues when aged 28. Later, HBV infection entered the non-replication phase with at least two episodes of reactivation in the fifth decade of life accompanied by jaundice. More studies examining hearing loss in patients with chronic HBV infection are encouraged to better understand their potential otologic needs.

Alcohol and the death of Ludwig van Beethoven: comparison of general biographies to the medical literature

Beethoven's autopsy findings of cirrhosis may have been due to alcoholism. This condition may have been underemphasized historically, given its stigma and the incongruence with the often heroic portrayal of Beethoven. We therefore aimed to compare how medical experts and biographers writing for a non-medical audience describe his final illness in the context of alcoholism. English-language biographies were identified using a survey of biographies of Beethoven and supplemented by the authors. English-language medical publications were identified by searching for "Beethoven" in the PubMed® MEDLINE database. We included studies that mentioned Beethoven's final illness and death. We recorded statements regarding alcohol consumption, alcoholism, or alcohol use disorder, and the role of alcohol in Beethoven's death. The most commonly cited final illness was liver disease. Alcohol use was more frequently mentioned in biographies, but alcoholism less so. Alcohol use was invoked as a possible cause of final illness more frequently by medical publications.

Genomic analyses of hair from Ludwig van Beethoven

Ludwig van Beethoven (1770-1827) remains among the most influential and popular classical music composers. Health problems significantly impacted his career as a composer and pianist, including progressive hearing loss, recurring gastrointestinal complaints, and liver disease. In 1802, Beethoven requested that following his death, his disease be described and made public. Medical biographers have since proposed numerous hypotheses, including many substantially heritable conditions. Here we attempt a genomic analysis of Beethoven in order to elucidate potential underlying genetic and infectious causes of his illnesses. We incorporated improvements in ancient DNA methods into existing protocols for ancient hair samples, enabling the sequencing of high-coverage genomes from small quantities of historical hair. We analyzed eight independently sourced locks of hair attributed to Beethoven, five of which originated from a single European male. We deemed these matching samples to be almost certainly authentic and sequenced Beethoven's genome to 24-fold genomic coverage. Although we could not identify a genetic explanation for Beethoven's hearing disorder or gastrointestinal problems, we found that Beethoven had a genetic predisposition for liver disease. Metagenomic analyses revealed furthermore that Beethoven had a hepatitis B infection during at least the months prior to his death. Together with the genetic predisposition and his broadly accepted alcohol consumption, these present plausible explanations for Beethoven's severe liver disease, which culminated in his death. Unexpectedly, an analysis of Y chromosomes sequenced from five living members of the Van Beethoven patrilineage revealed the occurrence of an extra-pair paternity event in Ludwig van Beethoven's patrilineal ancestry.

Metallic: A Bivalent Ambimodal Material Property?

Many metallic visual stimuli, especially the so-called precious metals, have long had a rich symbolic meaning for humans. Intriguingly, however, while metallic is used to describe sensations associated with pretty much every sensory modality, the descriptor is normally positively valenced in the case of vision while typically being negatively valenced in the case of those metallic sensations that are elicited by the stimulation of the chemical senses. In fact, outside the visual modality, metallic would often appear to be used to describe those sensations that are unfamiliar and unpleasant as much as to refer to any identifiable perceptual quality (or attribute). In this review, we assess those sensory stimuli that people choose to refer to as metallic, summarising the multiple, often symbolic, meanings of (especially precious) metals. The evidence of positively valenced sensation transference from metallic serviceware (e.g., plates, cups, and cutlery) to the food and drink with which it comes into contact is also reviewed.

Aetiology of Ludwig van Beethoven's hearing impairment: hypotheses over the past 100 years - A systematic review

OBJECTIVES

Even 250 years after Beethoven's birth, the irrevocable cause of his hearing impairment remains unclear despite multiple publications by different professional groups. This study aimed to analyse the development of the most likely aetiologies during the last 100 years by a systematic review of the relevant medical literature.

METHODS

A systematic review of medical literature in PubMed®, PubMed Central®, and Web of Science® for the period 1920-2020 was conducted. Medical publications between 1920 and 1935 were additionally searched manually by review of reference lists. Studies were eligible when a statement regarding the most likely aetiology of the hearing loss of Beethoven was the aimed objective of the publication.

RESULTS

48 publications were included. The following aetiologies were supposed: otosclerosis (n = 10), syphilis (n = 9), Paget's disease (n = 6), neural deafness (n = 5), immunopathy with inflammatory bowel disease, neural deafness with otosclerosis, sarcoidosis or lead intoxication (n = 2), and systemic lupus erythematosus, trauma, labyrinthitis or inner ear disease (n = 1). There is an ongoing effort with a mean publication frequency in this topic of 0.48/year. From 1920 to 1970, otolaryngologists were the group with the highest interest in this field (67%), whereas since 1971 most authors have belonged to non-otolaryngologic subspecialities (81%).

CONCLUSION

Over the past 100 years, otosclerosis and syphilis were predominantly supposed to be the underlying causes. The hypothesis of syphilis-although rejected for a long time-has had a remarkable revival during the past 20 years. Regarding the outcome following therapeutic intervention by cochlear implantation, the differential diagnosis of neural deafness would be relevant today.

Beethoven's death-the result of medical malpractice?

Two different strands of hair taken from Beethoven’s head after his death were examined for heavy metals using scanning electron microscopy (SEM) and laser ablation-ICP-MS (inductively coupled plasma–mass spectroscopy). The results revealed the presence of small lead particles on the surface of Beethoven’s hairs and fluctuating lead levels in hair medulla along the length of the hair due to alternating lead exposure, with an average lead exposure of 100 times the normal value. The time-line attached to the peaks of these fluctuating values correlate with the pneumonia treatment and the paracenteses performed, including the subsequent treatment of the procedure wounds. While the administration of lead-containing drugs and treatments had been proven to resolve the pneumonia, it had simultaneously caused massive liver failure, accelerated by pre-existing cirrhosis. The question as to whether Beethoven’s death was a case of malpractice can only be answered from a forensic point of view ex ante, since the state of the medical knowledge of the time has to be taken into account.

Metallic Sensation-Just an Off-Flavor or a Biologically Relevant Sensing Pathway?

Metallic off-flavors are a frequent theme in discussions of food product quality, with publications dating back over 90 years. The causes of this unpleasant perception are diverse, ranging from unfavorable concentrations of micronutrients, the use of artificial sweeteners, processing, packaging, and storage, to side effects of pharmaceutical or chemotherapeutic agents. However, the mechanisms behind metallic sensing and its contributions to taste, smell, and trigeminal nerve sensations are still poorly understood. Although even defining oral/nasal metallic sensation has proven difficult, thought should also be given to possible biological activities of food constituents eliciting a metallic sensation though activation of ectopically expressed chemoreceptors. This perspective seeks to summarize and connect research conducted on different food-borne stimuli of metallic sensation, their sensory evaluations up to more recent contributions addressing the mechanistic approaches to identify chemosensory-active food constituents, and their biological effects mediated by ectopically expressed chemosensory receptors. With this perspective, we hope to spark interest in fully characterizing the mostly unwanted metal off-flavor, thereby laying grounds for increased product quality on one hand and providing novel insights into chemosensory-associated biological functions of metallic sensation on the other hand, which might help to understand and combat these sensations experienced in various diseases and therapies, e.g., platinum-based chemotherapy.

A Modern Case Sheds Light on a Classical Enigma: Beethoven's Deafness

Two hundred and fifty years have passed since the birth of Ludwig van Beethoven, and the enigma about his hearing loss and overall health status seems to be not completely solved. However, the admission to the hospital of a 64-year-old woman in 2018 with symptoms extremely similar to those experienced by the great composer may add further evidence to a theory previously underestimated. The health issues of the modern patient were found to be due to chronic lead intoxication. The lead was released during daily cooking using a ceramic-coated frying pan with worn surface that poisoned her breakfast most probably for years. Abdominal pain, asthenia, and hearing loss affecting the high frequencies with a many impact on speech intelligibility tormented the patient, as they had Beethoven. An extensive review of the music and medical literature was performed, as well as re-examination of manuscripts, correspondence, and autopsy reports of the famous composer; and great similarities have been found. The soundness of the most-cited classical theories about Beethoven's hearing loss will be discussed. After close scrutiny of the theories, our analysis points toward a progressive sensorineural hearing loss due to lead intoxication as the most probable cause of not only Beethoven's hypoacusis but his overall health status as well. Laryngoscope, 131:179-185, 2021.

Serum concentration of toxic metals and rare earth elements in children and adolescent

Biomonitoring studies are important for quantifying the body burden of pollutants and their possible effects on health. Serum concentration of 42 elements was assessed by ICP-MS in 89 children (7.2 ± 3.4 years old) from Bucharest (Romania). Levels of pollutants were compared with the clinical data obtained from routine blood tests. Clinical parameters were in the physiological range. Deficiencies of manganese, selenium, and zinc were discovered. Blood levels of elements were low. The highest levels were observed among children younger than six years. The sum of iron, selenium, barium, nickel, antimony, and cerium was positively associated with hemoglobin (Spearman rho = 0.217, P-value = 0.041), while the sum of copper, thallium, niobium, and tantalum was negatively associated (Spearman rho = -0.228, P-value = 0.032). Given the inherent sensitivity of the child population, additional studies are needed to assess the effects of these elements on their health.

Beethoven: His Hearing Loss and His Hearing Aids

: To celebrate the 250th anniversary of the birth of the great classical composer, Ludwig van Beethoven (1770-1827), we point out how his hearing loss affected him and how the primitive hearing aids at that time helped mitigate his hearing loss. From the age of 26, Beethoven began to suffer from a fluctuating, progressive hearing loss ("my hearing grew worse and worse"), This started in his left ear ("in my left ear, with which this illness of my ears had started"), where he had difficulty hearing higher pitched tones ("I don't hear the high notes of the instruments and voices") and words ("Sometimes, I cannot hear people who speak quietly, I can hear the sounds, but not the words") and associated with tinnitus ("my ears, they still keep buzzing and humming day and night") and loudness recruitment ("if someone yells, it is unbearable to me").However, in spite of his hearing loss, Beethoven never lost his love for music and continued composing music, at times using some of the acoustic hearing aids that were just being developed. We analyze and describe the ear trumpets, and the resonant plate that engineer Johan Nepomuk Maelzel and piano-maker Conrad Graf, respectively, constructed to try to improve Beethoven's hearing. Moreover, we discuss the possible use of a wooden drumstick Beethoven might have used to improve his perception of the piano's sound.

Self-assembling two-dimensional nanophotonic arrays for reflectivity-based sensing

We propose a nanoplasmonic platform that can be used for sensing trace levels of heavy metals in solutions via simple optical reflectivity measurements. The considered example is a lead sensor, which relies on the lead-mediated assembly of glutathione-functionalized gold nanoparticles (NPs) at a self-healing water/DCE liquid | liquid interface (LLI). Capillary forces tend to trap each NP at the LLI while the negatively charged ligands prevent the NPs settling too close to each other. In the presence of lead, due to chelation between the lead ion and glutathione ligand, the NPs assemble into a dense quasi-2D interfacial array. Such a dense assembly of plasmonic NPs can generate a remarkable broad-band reflectance signal, which is absent when NPs are adsorbed at the interface far apart from each other. The condensing effect of the LLI and the plasmonic coupling effect among the NP array gives rise to a dramatic enhancement of the reflectivity signals. Importantly, we show that our theory of the optical reflectivity from such an array of NPs works in perfect harmony with the physics and chemistry of the system with the key parameter being the interparticle distance at the interface. As a lead sensor, the system is fast, stable, and can achieve detection limits down to 14 ppb. Future alternative recognizing ligands can be used to build sister platforms for detecting other heavy metals.

We propose a nanoplasmonic platform that can be used for sensing trace levels of heavy metals in solutions via simple optical reflectivity measurements at the liquid–liquid interface.

Beethoven's autopsy revisited: A pathologist sounds a final note

This review of the original autopsy report of Beethoven's remains indicates Paget's disease within the skull, which was dense and twice normal thickness, with dilated vessels at the petrous bone. The facial nerves were enlarged and the eighth nerves atrophied despite their sharing a common meatus at the internal auditory canal. Nephrolithiasis and pyelonephritis with cortical and perinephric abscesses were also reported. The hypercalcaemia was probably caused by hyperparathyroidism, which may be associated with Paget's disease, and both may have played a role in his psychiatric symptoms as well as in his abdominal pain and gastrointestinal complaints. Since Paget's disease may also be associated with gout, some of the joint pains could be attributable to this as well. Hypovitaminosis A from chronic pancreatitis is suggested as a cause of painful eyes and either quinine abuse or severe hypercalcaemia as a cause of arrhythmias. Beethoven died of terminal cirrhosis with chronic pancreatitis, most likely related to chronic excessive intake of alcohol. Thus, Paget's disease, complicated by hyperparathyroidism, gout, and attempts to find relief of symptoms through the use of alcohol, quinine, and possibly salicylates can explain virtually all of Beethoven's medical problems, some of which appear to have influenced his musical compositions.

The Adverse Effects of Heavy Metals with and without Noise Exposure on the Human Peripheral and Central Auditory System: A Literature Review

Exposure to some chemicals in the workplace can lead to occupational chemical-induced hearing loss. Attention has mainly focused on the adverse auditory effects of solvents. However, other chemicals such as heavy metals have been also identified as ototoxic agents. The aim of this work was to review the current scientific knowledge about the adverse auditory effects of heavy metal exposure with and without co-exposure to noise in humans. PubMed and Medline were accessed to find suitable articles. A total of 49 articles met the inclusion criteria. Results from the review showed that no evidence about the ototoxic effects in humans of manganese is available. Contradictory results have been found for arsenic, lead and mercury as well as for the possible interaction between heavy metals and noise. All studies found in this review have found that exposure to cadmium and mixtures of heavy metals induce auditory dysfunction. Most of the studies investigating the adverse auditory effects of heavy metals in humans have investigated human populations exposed to lead. Some of these studies suggest peripheral and central auditory dysfunction induced by lead exposure. It is concluded that further evidence from human studies about the adverse auditory effects of heavy metal exposure is still required. Despite this issue, audiologists and other hearing health care professionals should be aware of the possible auditory effects of heavy metals.

Hearing loss in palliative care

BACKGROUND

Age-related hearing loss is remarkably common, affecting more than 60% of adults over the age of 75. Moreover, hearing loss has detrimental effects on quality of life and communication, outcomes that are central to palliative care. Despite its high prevalence, there is remarkably little written on the impact of hearing loss in the palliative care literature.

OBJECTIVE

The objective was to emphasize its importance and the need for further study. We use a case as a springboard for discussing what is known and unknown about the epidemiology, presentation, screening methodologies, and treatment strategies for age-related hearing loss in palliative care.

DISCUSSION

The case describes a 65-year-old man with acute myelogenous leukemia (AML) that has progressed despite treatment. No concerns are raised about communication challenges during conversations between the palliative care team and the patient in his quiet room. However, in the midst of a family meeting, shortly after discussing prognosis, the patient reports that he cannot hear what anyone is saying.

CONCLUSION

We describe simple methods of screening patients for hearing loss, and suggest that practical approaches should be used universally in patient encounters. These include facing the patient, pitching one's voice low, using a pocket talker, and creating a hearing-friendly environment when planning a family or group meeting.