The researchers were careful not to overstate the finding. They described the three factors—genetic predisposition, alcohol, and hepatitis B—as possible contributors, each adding to the risk profile rather than any one being the sole cause. Strassburg and his colleagues noted that it was not possible to determine from the available data whether the hepatitis B infection had been a chronic lifelong condition or a more recent exposure, and that without knowing this, the relative weight of each factor in causing his death could not be precisely assigned.
“We cannot say definitively what killed Beethoven,” Krause stated in comments accompanying the study’s release.
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## The Deafness That Could Not Be Explained
If the liver disease findings offered a measure of clarity—a convergence of factors that could plausibly account for his death—the findings on his deafness offered something quite different: a confirmation of uncertainty.
Beethoven began losing his hearing in his mid-twenties. The first symptoms he described in his letters date to around 1796, when he was 25 or 26. At first the loss was intermittent and partial. By 1801 he was writing to friends about a hearing that had deteriorated significantly over three years. By 1818, he had given up spoken conversation and relied entirely on the small notebooks—conversation books—in which visitors wrote their side of any exchange, while he responded verbally or in writing.
The progression from early symptoms in 1796 to complete deafness by the late 1810s took more than two decades, and the cause was never satisfactorily explained during his lifetime. Beethoven himself once linked the onset to a violent quarrel with a tenor in 1798, in which a fall was involved. His physicians tried numerous treatments—herbal remedies, danube baths, blistering bark applied to his forearms, leeches, bloodletting, galvanic electrical stimulation. None helped. An autopsy after his death found abnormalities in the auditory nerves and surrounding structures of the ear, and later medical historians have proposed various explanations, including otosclerosis (abnormal bone growth in the middle ear), damage to the auditory nerve from an infectious illness, and other conditions.