Music · Medicine · BrainAll chapters

CHAPTER 07 · Medical Problems of Musical Masters

The Onset of Silence: Beethoven’s Battle with Deafness

Phillip L. Pearl, MD, FAES, FACNS · Robert D. Bunning, MD, FACP, FACR · Saman Arfaie, MD, CM

ABOUT THE AUTHORS

Abstract

Beethoven's deafness remains a highly disputed topic and one of the most profound and paradoxical medical issues faced by any historical figure in Western music. This chapter analyzes the medical literature surrounding Beethoven's progressive deafness from his late twenties, beginning with his left ear and gradually affecting both ears. Despite this tragic limitation, Beethoven's use of ear trumpets navigated his continued musical compositions. Various medical etiologies ranging from typhoid fever and lead poisoning have been proposed as possible culprits, although historical medical records or post-mortem findings confirm no definitive diagnosis. The authors suggest that Paget's disease is a likely candidate for explaining his clinical findings.

Keywords

Explore the book at Cambridge University Press

REFERENCE THIS CHAPTER

Cite this chapter

Chapter references below omit unverified page ranges and chapter-specific DOIs.

APA

Pearl, P. L., Bunning, R. D., & Arfaie, S. (2026). The Onset of Silence: Beethoven’s Battle with Deafness. In P. L. Pearl & S. Arfaie (Eds.), Music, Medicine, and the Neurobiology of Creativity. Cambridge University Press.

AMA

Pearl PL, Bunning RD, Arfaie S. The Onset of Silence: Beethoven’s Battle with Deafness. In: Pearl PL, Arfaie S, eds. Music, Medicine, and the Neurobiology of Creativity. Cambridge University Press; 2026.

Vancouver

Pearl PL, Bunning RD, Arfaie S. The Onset of Silence: Beethoven’s Battle with Deafness. In: Pearl PL, Arfaie S, editors. Music, Medicine, and the Neurobiology of Creativity. Cambridge: Cambridge University Press; 2026.

Chicago

Pearl, Phillip L., Robert D. Bunning, and Saman Arfaie. “The Onset of Silence: Beethoven’s Battle with Deafness.” In Music, Medicine, and the Neurobiology of Creativity, edited by Phillip L. Pearl and Saman Arfaie. Cambridge University Press, 2026.

BibTeX

@incollection{chapter7_2026,
  author = {Pearl, Phillip L and Bunning, Robert D and Arfaie, Saman},
  title = {The Onset of Silence: Beethoven’s Battle with Deafness},
  booktitle = {Music, Medicine, and the Neurobiology of Creativity},
  editor = {Pearl, Phillip L. and Arfaie, Saman},
  publisher = {Cambridge University Press},
  year = {2026}
}

Harvard

Pearl, P. L., Bunning, R. D. and Arfaie, S. (2026) “The Onset of Silence: Beethoven’s Battle with Deafness”, in Pearl, P.L. and Arfaie, S. (eds.) Music, Medicine, and the Neurobiology of Creativity. Cambridge: Cambridge University Press.

Phillip L. Pearl

Phillip L. Pearl

MD, FAES, FACNS

Director of Epilepsy and Clinical Neurophysiology | Boston Children’s HospitalWilliam G. Lennox Chair and Professor of Neurology | Harvard Medical School

Harvard Medical School · Boston Children’s Hospital

Profile

Phillip L. Pearl is Director of Epilepsy and Clinical Neurophysiology at Boston Children’s Hospital and William G. Lennox Chair and Professor of Neurology at Harvard Medical School. He studied at Johns Hopkins University and the Peabody Conservatory of Music before attending the University of Maryland School of Medicine. His research focuses on inherited metabolic epilepsies, particularly disorders of GABA metabolism. A physician and musician, he has published extensively at the intersection of music and medicine and is Co-Editor in Chief of the seventh edition of Swaiman’s Pediatric Neurology.

Scholarship & professional background

His postgraduate training included a pediatric neurology residency at Texas Children’s Hospital and Baylor College of Medicine, followed by fellowship training at Boston Children’s Hospital. Alongside his work on GABA-related disorders, he has developed educational projects connecting neurology with art and music, including Neurology Through Art and Time. His own musical practice encompasses jazz piano, vibraphone, and drums, informing a sustained interest in how musical experience and clinical neuroscience illuminate one another.

He also serves as Co-Director of the Epilepsy Center at Boston Children’s Hospital. He is a Fellow of the American Epilepsy Society and of the American Clinical Neurophysiology Society, and a past president of both the Child Neurology Society and the Professors of Child Neurology. His honours include the American Epilepsy Society’s 2024 Fritz E. Dreifuss Award.

Selected work & perspectives

Phillip L. Pearl · Boston Children’s HospitalSwaiman’s Pediatric Neurology: Principles and Practice · Seventh editionNeuro-Logic: A Primer on LocalizationInherited Metabolic Epilepsies · Second editionResearch, publications, and clinical neuroscienceMusic, epilepsy, and the brain · International League Against EpilepsyFellowship and Fritz E. Dreifuss Award · American Epilepsy SocietyClinical neurophysiology credentials and pediatric EEG guidelines
Robert D. Bunning

Robert D. Bunning

MD, FACP, FACR

Rheumatologist and Musician; Former Director, Rheumatology Program

MedStar National Rehabilitation Hospital

Profile

Robert D. Bunning is a rheumatologist and musician whose work connects clinical medicine with a lifelong engagement in music. He earned a bachelor’s degree in music at Princeton University, where his thesis examined the piano style of Erroll Garner, and studied medicine at the University of Cincinnati. He trained in internal medicine and rheumatology at MedStar Washington Hospital Center. His research has addressed NSAID-related renal toxicity, atypical femoral fractures, delayed lead toxicity from retained bullet fragments, and cobalt toxicity associated with hip replacements. He directed the rheumatology program at MedStar National Rehabilitation Hospital. A 1983 Medical Grand Rounds presentation on Beethoven’s deafness helped establish his enduring interest in music and medicine. He now devotes more time to music, leading One Night Samba and the vocal quartet The Brothers Flanagan.

Scholarship & professional background

His musical practice has also supported research through public performance. At Georgetown’s Music for the Mind event, he performed as a pianist in a program bringing musicians and neuroscientists together to support neuroplasticity research. This activity reflects a longstanding engagement with music as both an artistic practice and a point of contact between clinical medicine and the wider community.

Selected work & perspectives

Music and medicine: reflections from rheumatologyMusic for the Mind · Georgetown University
Saman Arfaie

Saman Arfaie

MD, CM

Neurology Resident Physician | McGill University Health Centre (MUHC)MSc Candidate, Integrated Program in Neuroscience | McGill University, Montreal Neurological Institute (The Neuro)

McGill University · University of California, Berkeley

Music, memory & creative expression

Saman Arfaie is an Adult Neurology resident physician, neuroscience researcher, and classically trained pianist whose interests connect music, memory, creativity, and neurological disease, with particular attention to the late works of Schubert and Beethoven.

A pianist for more than two decades, he has studied with Tatiana Dardykina, DMA; Jui Sheng Li, DMA; and Dane Ko, DMA, and pursued musicology at the University of California, Berkeley with Professors James Q. Davies and Nicholas Mathew. He presented Echoes of Time & Memory: The Late Piano Works of Schubert at the American Osler Society’s 2026 meeting in Toronto and a Chopin lecture-recital at TEDxMcGill.

Neuroscience & clinical research

At the McGill University Health Centre and Translational Neuroimaging Laboratory, he studies neurodegeneration through fluid biomarkers, PET, and MRI, including Alzheimer’s disease biomarkers, alpha-synuclein pathology in Lewy body disease, vascular modifiers of progression, and Parkinson’s disease subtypes. He uses stereoelectroencephalography to investigate epileptic networks and brain-state transitions, including the effects of radiofrequency thermocoagulation, and contributes to clinical trials through McGill’s Clinical Research Unit.

Education & scholarship

He completed his MD, CM at McGill after earning dual degrees in Molecular and Cell Biology, with an emphasis in Neurobiology, and Near Eastern Languages and Literature at Berkeley, with minors in Chemistry and Music. He is an MSc candidate in McGill’s Integrated Program in Neuroscience. His interdisciplinary monograph COVID-19 Contextualized is under review at the University of Calgary Press. He contributed “Robert’s Health Issues” to Clara and Robert Schumann in Context, and his public engagement includes five TEDx talks.

Selected work & perspectives

Saman Arfaie · Music, repertoire & academic workClara and Robert Schumann in Context · Cambridge contributor biographiesMusic, medicine, and public speaking · McGill University