There are many passages in Beethoven's music where his use of rhythmic disturbances—including obsessive and extended syncopation or repetition, fragmentation, and dislocation—conveys an unprecedented musical realism. I propose that during the creative process Beethoven sought and found rhythmic and harmonic parallels to his physical suffering, particularly his experience of tinnitus. Whereas music before Beethoven certainly expressed emotional conditions through dissonance, harmonic tension, and rhythmic patterns, Beethoven's dislocated and disruptive rhythms go beyond the compositional norms of his time. This is realistic music, perhaps more realistic physically and emotionally than anything written before Janáček, who wrote that his musical ideas must “come out of the depths where thought touches the blood.”

It may seem odd to quote Janáček when discussing Beethoven, but the connection is telling. Certainly Janáček was not the first composer to feel that “a chord is a being come alive: a blood-stained flower of the musical art.” Janáček expressed in words the intense association of tones to emotion, and emotion to the body. Similarly conveying the sense that music itself has physicality, Beethoven said of ideas, “I could seize them with my hands.”

As early as 1806, Beethoven wrote in the margins of his sketchbook for the “Razumovsky” Quartets: “Let your deafness no longer be a secret—even in art.” Surely, this proclamation must be taken seriously, and while no musical manifestation of his deafness can be definitively proved, the challenge to discover passages that musically proclaim Beethoven's struggle with aspects of deafness is worth investigating.

The Vivace of opus 135 can be heard as a depiction of the physical manifestations of tinnitus as well as the struggle to hear high-pitched sounds, a common symptom of partial deafness. While the common conception of tinnitus is a ringing in the ears, there are other presentations of the disorder: