I wanted to use myself as an example to explain on a personal level why it
is so important to understand the importance of what a conductive loss is
really like, and why otosclerosis will never hold up to be a legitimate
theory in Beethoven's case.

I have no middle ear to speak of in my left ear.  I have an ear drum
but I do not have air conduction because I do not have ossicles-stapes to
transmit sound via air to my inner ear, the sensorineural part of hearing.
So in essence, though I wear a canal hearing aid, the effect is really
called bone conduction.  The acoustical energy emitted by my hearing aid
is absorbed by bone.  Sound does not travel through my middle ear by air.
This means that I have the maximum conductive loss one can have on an
audiogram.  The loss in my left ear is worse than the loss that can be
caused by the disease otosclerosis.

My right ear is better.  My conductive loss is moderate like otosclerosis.
My speech reception threshold is 35-45 decibels.  Otosclerosis can cause up
to 60 dbs loss.  My left ear is 85 dbs speech reception threshold.  So in
my right ear I have air conduction so sound travels through my middle ear.
If I put in my aid in my ear but do not turn it on, this will act as a
blocker for sound to travel through my right ear.

What is my point?

When I was younger, I used to go to disco clubs.  I would sometimes take
out my aids or cut them off but leave them in.  Yet, the music was still
LOUD.  I could hear.  In fact, I heard conservation better than normal
hearing people because my ears were not amplifying the already too loud
music so sitting next to people talking was not problem since they had to
talk above the music.  About 8 yrs ago, I attended a concert of Beethoven's
9th symphony.  I listen with my aids and I took them out and listen to the
music to sample the effect out of curiosity.  How is this possible? Am I
not supposed to be deaf? After all my loss is worse than otosclerosis, the
disease that is suggested Beethoven had.  And when I mow the grass I use an
ear plug in my right ear (better ear) to further protect my hearing from
the noise.  I use the telephone on my right side without aid all the time.

So one has to understand that when I read that Beethoven had otosclerosis,
a conductive loss, I look at that as an absurdity.

I thought about bringing this up to one of my doctors, a professor at
a leading university.  An otolaryngologist, he is the leading expert
on congenital atresia, pioneering the surgery to build ear canals when
there is not one.  He has operated on the middle ear many times including
otosclerosis cases.  Presently, I am now discussing with him about
operating on my left ear.  He operated on my niece and accomplished what
he set out to do.  In my case it is rather complicated; I say he can
improve it perhaps by air conduction, he says he still thinks it will be
bone conduction.  I am arguing with a professor that I think it is worth
the risk.  First he agrees, but then I ask too many questions, now he backs
off again.  So I send him more of my past audiograms for evaluation this
week.  Now he knows my background that I used to do hearing tests as a
hearing aid consultant.

So I thought I would bring up the subject of Beethoven.  It would be surly
be embarrassing for me to ask him if he thought Beethoven had otosclerosis,
him knowing what I know.  So what if I show him some paragraphs describing
Beethoven's hearing loss, especially in his last days not even able really
to his own music, not able to have conservation because his hearing had
left him almost in complete silence.

"But there it is Doc, in print that some in the medical world think
Beethoven had fusion of middle bones and that is why he could not hear." At
this point, he is looking at his watch, being a busy man.  "You wouldn't
happen to know anything about venereal diseases would ya?"

I plan to figure out a way to explore his thoughts on this subject.
He first has to come to the type of loss--sensorineural or mix
(conductive+sensorineural).  Does Beethoven demonstrate a conductive loss
in the beginning that leads to sensorineural(cochler otosclerosis) disease.
As Dr.  Wharton wrote on an earlier post, Beethoven showed classic nerve
loss in the very beginning.  That and many other descriptions make cochlear
otosclerosis not likely worth considering.  Now comes the challenge of why
did Beethoven develop a sensorineural so early in life? It becomes vital to
look at cases today-people with diseases that effect their hearing to see
how their audiograms compare to others.  In other words, asking an ear
specialist if his training allows him to recognize different kinds nerve
loss with what is possible.

Some important clues:tinnitus, high frequency loss at an early age.  Not
even I would discount bowel movements if Beethoven thought it had something
to do with his hearing.  I have had many strange episodes that demonstrate
the unity of the body but it will a hard sell for a doctor to see a
connection.  Who knows?

There are a lot of symptoms that are applied to Beethoven in isolation.
By itself it fits a certain disease but when looking at the whole picture
of Beethoven's life it has to be discarded.  For example, otosclerosis is
mention because Beethoven complained of noise in his ear, yet this applies
to sensorineural loss.  And many other examples are out there so a doctor
has to wade through all this stuff to get to his expert opinion.  There are
stories about Beethoven that seem to be important clues but I do not think
a doctor would give much weight to it if at all.  I could go through some
of them as well but maybe another time would be better.

I think the only way Beethoven could have suffered a mix loss is when
his doctors tried to help and Beethoven says they made his hearing worse.
However, if true it is not likely they could affect his nerve loss and may
have created a short term conductive loss affecting his outer ear+middle
ear by infections.  I experience this myself and wonder if Beethoven was
referring to this but clearly he was on a course to deafness regardless.

I also plan to visit my previous otolaryngologist who retired several yrs
ago.  Maybe I can pick his brain and find that two heads are better than
one.

Glenn Miller