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When I was training as a composer, I forced myself to not rely on the piano as much as possible for pitch references and such. You basically learn to internalize everything and with perfect pitch, it becomes second nature. This is sort of why it wasn't really an obstacle for Beethoven to make music despite being deaf as he could conceptualize how it would sound. Of course the actual orchestrations at times were wonky because it was a period of experimentation of orchestra sizes and colour and such and that , he had no reference. But anyways, most composers learn this way and I would say a good portion of the better ones prefer it this way. The piano tends to introduce an element that can taint your musical vision as it tends to emphasize a certain aesthetic.
I regularly go thru scores and can hear the symphony in its entirety just by seeing the notes. I think even those that don't think it is in their heads have to play what they like and then it ends up in their head, and then they make a decision that they like it.
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