Smith and colleagues1 concluded that Goya most likely had the very rare Susac’s syndrome, dismissing, in a single sentence, syphilis, which is in my view by far the likeliest cause, for the following reasons:

• Epidemiological: Goya went suddenly deaf2, 3 in both ears in his mid-forties. The peak onset of luetic deafness is 40–50 years.4 Contrary to Smith et al’s1 claim that acute bilateral deafness is mainly idiopathic, 47% of middle aged men were luetic …