BrazJOtorhinolaryngol.2016;82(1):97---104
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
REVIEW
ARTICLE
Tinnitus
and
cell
phones:
the
role
of
electromagnetic
radiofrequency
radiation
夽
Luisa
Nascimento
Medeiros
a,b,
Tanit
Ganz
Sanchez
b,c,∗aDepartmentofOtolaryngology,FaculdadedeMedicina,UniversidadedeSãoPaulo(USP),SãoPaulo,SP,Brazil bAssociationforInterdisciplinaryResearchandDivulgationofTinnitus,SãoPaulo,SP,Brazil
cFaculdadedeMedicina,UniversidadedeSãoPaulo(USP),SãoPaulo,SP,Brazil
Received20December2014;accepted17April2015 Availableonline21September2015
KEYWORDS Cellularphone; Electromagnetic radiation; Tinnitus
Abstract
Introduction:Tinnitusisamultifactorialconditionanditsprevalencehasincreasedonthepast decades.Theworldwideprogressiveincreaseoftheuseofcellphoneshasexposedthe periph-eralauditorypathwaystoahigherdoseofelectromagneticradiofrequencyradiation(EMRFR). Sometinnituspatientsreportthattheabusiveuseofmobiles,especiallywhenrepeatedinthe sameear,mightworsenipsilateraltinnitus.
Objective: Theaimofthisstudywas toevaluatetheavailable evidenceaboutthepossible causalassociationbetweentinnitusandexposuretoelectromagneticwaves.
Methods:A literaturereviewwas performedsearchingforthefollowing keywords:tinnitus, electromagneticfield,mobilephones, radiofrequency,andelectromagnetichypersensitivity. Weselected165articlesthatwereconsideredclinicallyrelevantinatleastoneofthesubjects.
Results:EMRFR canpenetrate exposed tissuesand safetyexposurelevelshave been estab-lished.Thesewavesprovokeprovedthermogeniceffectsandpotentialbiologicalandgenotoxic effects.Someindividualsaremoresensitivetoelectromagneticexposure(electrosensitivity), andthus,presentearliersymptoms. Theremaybeacommonpathophysiologybetween this electrosensitivityandtinnitus.
Conclusion: Therearealreadyreasonableevidencestosuggestcautionforusingmobilephones topreventauditorydamageandtheonsetorworseningoftinnitus.
© 2015Associac¸ãoBrasileira de Otorrinolaringologiae CirurgiaCérvico-Facial. Publishedby ElsevierEditoraLtda.Allrightsreserved.
夽 Pleasecitethisarticleas:MedeirosLN,SanchezTG.Tinnitusandcellphones:theroleofelectromagneticradiofrequencyradiation. BrazJOtorhinolaryngol.2016;82:97---104.
∗Correspondingauthor.
E-mail:tanitsanchez@gmail.com(T.G.Sanchez). http://dx.doi.org/10.1016/j.bjorl.2015.04.013
1808-8694/©2015Associac¸ãoBrasileirade OtorrinolaringologiaeCirurgiaCérvico-Facial.Published byElsevierEditoraLtda.Allrights
PALAVRAS-CHAVE Telefonecelular; Radiac¸ão eletromagnética; Zumbido
Zumbidoetelefonescelulares:opapeldaradiac¸ãoeletromagnética deradiofrequência
Resumo
Introduc¸ão:Zumbidoéumacondic¸ãomultifatorialcujaprevalênciavemaumentandonas últi-mas décadas.Em todoo mundo,oaumento progressivodo usode telefones celulares tem expostoasorelhasaumamaiorcargaderadiac¸ãoeletromagnéticaderadiofrequência(REM-RF). Algunspacientescomzumbidoreferemqueousoexcessivodotelefonecelular,especialmente quandosemprenamesmaorelha,éumfatordepioradozumbidoipsilateral.
Objetivo:O objetivo deste trabalho foi avaliar as evidências disponíveis sobre a possível associac¸ãocausalentrezumbidoeexposic¸ãoaondaseletromagnéticas.
Método: Foi realizada uma revisão de literatura com palavras-chave como: tinnitus, elec-tromagnecticfield,cellularphone,radiofrequency,electromagnectichypersensitivity.Foram selecionados165artigoscommaiorrelevânciaclínicaempelomenosumdosassuntos.
Resultados: AsREM-RFpodempenetrartecidosexpostoseexistemníveissegurosdeexposic¸ão. Apresentamefeitostermogênicoscomprovadosepotenciaisefeitosbiológicosegenotóxicos. Algunsindivíduossãomaissensíveisàexposic¸ãoeletromagnética(eletrossensibilidade)e, por-tanto, adquirem sintomas precocemente. A fisiopatologia da eletrossensibilidade pode ser semelhanteàdozumbido.
Conclusão:Consideramosqueháevidênciassuficientesquesugeremmaiorcautelaparaouso desses aparelhoseassim prevenirlesõesnaviaauditivae oaparecimento/agravamentodo zumbido.
©2015Associac¸ãoBrasileira deOtorrinolaringologiaeCirurgiaCérvico-Facial.Publicadopor ElsevierEditoraLtda.Todososdireitosreservados.
Introduction
Tinnitusischaracterizedbysoundperceptionintheabsence of an external source.1 Its prevalence has been increas-ing considerably in epidemiological studies, thus several international scientificevents and publications have been devoted to explore this subject. Among adults from the UnitedStates,Shargorodsky2foundaprevalenceof25.3%for tinnitus,asopposedto15%forthe samepopulation, pub-lished 15years previously(National Institutes of Deafness andOtherCommunicationDisorders,1995).3Inastudywith 506childrenbetween5and12yearsold,31%reported tinn-itusaccordingtorigorouscriteria,and19%wereannoyedby thesymptom.4
Although many people with tinnitus have no limita-tionon their quality of life, physicians, audiologists, and psychologists commonly receive patients who report that tinnitusleads tosleepdisorders,5,6 lack ofconcentration, andimpairmentinsociallifeandemotionalbalance.5,7
Thesefindingsjustifythesearchforexplanationsforthe gradualincrease oftinnitus indifferent age groups. Plau-sible possibilities include increased longevity;8 early and enhancedexposuretoloudnoises(environmentalorthrough earphones);8---10 higher levelsof occupational stress, caus-inganxietyanddepression;9,11,12 increaseduse ofalcohol, tobacco,andillicitdrugs;sedentarylifestyle;cardiovascular ormetabolicdiseases;etc.8
Another suspect being strongly considered for the increaseoftinnitusonsetistheexposuretoelectromagnetic radiation(EMR).13Infact,inclinicalpractice,somepatients havespontaneouslymentionedhearingsymptomsduringor shortlyafterusingcellphones,suchaswarmthorpressurein
theearthatisincontactwiththedevice,aswellastinnitus, reducedunderstanding,ordistortioninhearingfrequency. Thereisevenasmallgroupofpatientswhoreporttinnitus onsetorworseningassociatedwithlivingorworkingaround cellular,radio,andTVantennas.
Non-ionizing electromagnetic radiofrequency radiation (EMRFR) is routinely used for telecommunications (radio, TV,WiFi,cellularandcordlessphones,andradar).As expo-sure to thistype of radiation is progressively increasing14 worldwide,thereisagreaterinterestinitspossible harm-fuleffectsonhealth.15 Moresensitiveindividualsreported broad and unspecific symptoms like headache, dizziness, fatigue, memory impairment, sleep disorders, anxiety, myalgia,arthralgia,tearing,hearingloss,andtinnitus.16The problematicissueregardingunspecificsymptomsisthatthe correctcausalassociationisrarelyconfirmed.
Althoughseveralhypothesesindicateapossible involve-ment ofEMRFR in theonsetor worseningof tinnitus,this relationshiphasnotbeenwell-establishedandthe mecha-nismbywhichitwouldhappenremainsunclear.17
Theobjectiveofthisstudywastoperformasystematic review ofthecurrent knowledgeontinnitusandexposure toEMRFR,analyzingtheevidenceontheirpossible relation-ship.
Methods
Theroleofelectromagneticradiofrequencyradiation 99
(evaluating evidence from randomizedclinical trials with regardtoaparticularintervention).
AcarefulliteraturereviewwasperformedinthePubMed databasebetweenMayandJuneof2014,searchingforthe following descriptors: tinnitus AND electromagnetic field (144results),tinnitusANDcellphones(11results),tinnitus AND radiofrequency (eight results), tinnitus AND electro-magnetichypersensitivity(tworesults).Atotalof165items were found and read. Afterwards, the 45 studies that demonstrated clinical significance in at least one of the subjects(tinnitusandelectromagneticradiation)or inthe possiblelinkestablishedbetweenthemwereselected.
StandardsforregulationofexposuretoEMRFRpostulated by Brazilian National Telecommunications Agency (Agên-ciaNacionaldeTelecomunicac¸ões)occupationallevelsand users18werealsoanalyzed.
Aprintedmanuscriptusedtosuccessfullyargueagainst thedeploymentofcellularantennasinresidentialbuildings wasalsoincluded.Despitenothavingbeenpublished,it con-tainsscientificreferencesinagreementwiththedatafound inPubMed,aswellasstandardsforsafeexposuretoEMRFR.
Results
Forclarity,theresults ofthis reviewwillbepresented as items.
Exposuretoelectromagneticradiation(EMR)
EMR can be ionizing or non-ionizing. The latter does not produceionizationof molecules,butcancauseelectrical, chemical,andthermodynamiccell damage.19 Examplesof this group areinfrared, ultraviolet, laser, radiofrequency, andmicrowaveradiation.
EMRFR consistsofelectromagneticwaveswith frequen-cies between 3kHz and 300GHz,20 so a part of them can stimulatetheauditorysystem.Theyareproducedbynatural orsyntheticsourcesandmaypenetratetheexposedtissues. Therateofabsorptionofsuchenergydependsonthepower oftheEMRFRandthetissue’scharacteristics.Theabsorbed rateisconvertedintoheat.21Tomeasurethethermaleffect ofelectromagneticradiation onthe humanbody,the spe-cificabsorptionrate(SAR)isused,whichisameasureofthe powerdensityperunitmass.TheSARquantifiestheenergy absorbedbythetissue,whichisdirectlyproportionaltothe localincreaseoftemperature.19
International organizations have established limits for exposuretogeneralsourcesofEMRFR.SARvaluessetbythe InternationalCommissiononNon-IonizingRadiation Protec-tion(ICNIRP),anindependentscientificorganizationbased inGermany,formallyrecognizedbytheWorldHealth Orga-nizationandadoptedbyANATELare:18,22
• Occupationallimit:0.4W/kg
• Generalpubliclimit:0.08W/kg
Specificallyforcellphones,becausetheyareusednear tothehead orbody, theICNRPdeterminedthatthe local SARshouldnotexceedthe averagelimitof 2W/kgin 10g of tissue.23 Those limits aim topreventeffects tohuman health and reflect the current state of knowledge. Thus,
theSARlimitscurrentlyadoptedwereestablished primar-ily to prevent thermal effects related toincreasing body temperature.23
Although cell phones have much lower thermogenic potential than the maximum limits, heating of ear skin (2.3---4.5◦C)isacommoncomplaint,aswellasproven tem-peratureriseintympanicmembrane(0.02◦C).Suchheating varies according to the device frequency and duration of use;thelongerthecontactdurationbetweencellphoneand theear,thegreatertheexpectedheating.Dataonincreased braintemperatureisstillinsufficient.15
Inadditiontothethermaleffects,biologicaleffectshave alsobeendiscussed.24 AspecificconcernispossibleEMRFR cell genotoxicity, which has been studied in human lym-phocytes in six independents centers.25 The presence of chromosomalandmicronuclear alterationswasevaluated, butitwasnotpossibletoestablisharelationshipbetween EMRFRandgenotoxicity.25
The current functions of cell phones, with the advent of smartphones, go beyond regular phone calls. The widespread use of 3G wireless and Bluetooth functions entailsanadditionalconcernfortheauditorysystem. How-ever,recent studieshave notindicated adverse effectsof Bluetoothontheauditorysystem.26,27
Although little damage has been demonstrated so far, thestudyofEMRFReffectsondifferentorgansandsystems shouldremainofutmostimportancein publichealth.Any provenharmfuleffectcanhavewide-rangingimplications, duetotheuniversalexposuretoEMRFR.28 Inaddition, fur-therresearchshouldalwaysmonitorthepresenceofpossible harmsinmediumandlongterm.
In contrast, a study published29 in 1992 showed sub-stantial evidence that when pre-exposed tolow doses of DNA-damagingfactorssuchasionizingradiation,ultraviolet light,alkylatingagents,andoxidants,cellscandevelopan adaptiveresponse,withconsequentlygreaterresistanceto higherdosesofaggressiveagents. Themannerbywhichit occursisnotcompletelyelucidated,buttheroleoftheDNA’s repairmechanismhasbeendemonstrated,30withactive par-ticipationofproteinp53.31 Fromtheclinicalpointofview, thisadaptive possibilitymight beone of thereasons why somepatientsaremoresensitiveandothersaremore resis-tanttothesamedegreeofexposuretothesameaggressive agents.
TinnitusandEMRFR:thequestion ofelectromagnetichypersensitivity
Varioussymptomsinvolvingoneormoreorgansonthesame individualhavealreadybeenrelatedtotheexposureto elec-tromagneticfields.32Approximately3%---5%ofthepopulation subjectivelyassociates the presence of nonspecific symp-tomstoacuteorsubacuteexposuretoEMRFR,evenatlevels belowthesafelimitofexposure.33,34
Thesesymptomswere generallyreferred toas electro-magnetichypersensitivity(EMH)orelectrosensitivity.35 The termEMHcanbeusedintwocontexts:
Medeiros
LN,
Sanchez
TG
Table1 Comparisonoftheextracteddatafromthemainarticlesofthepresentreview.
Authors,Journal,Year Studydesign Patients(n) Presenceof tinnitus
PresenceofEMH ExposuretoEMRFR Association tinnitus-EMRFR
Hutteretal.(Environ Med2010)
Case-control n=100 (Austria)
n=100 Notreported Useofmobilephone analyzed
Tinnitusassociatedwith highintensityandlong durationofmobilephone use:≥4yearsofuseOR
1.95(95%CI1.00---3.80),
≥10min/dayOR1.71
(95%CI0.85---3.45),≥160
cumulativehoursofuse OR1.57(95%CI 0.78---3.19)
Bortkiewiczetal.(IntJ OccupMedEnviron Health2012)
Double-blind, randomizedtrial
n=10 (Poland)
Notreported Notreported Useofmobilephone analyzed (continu-ous×intermittent×sham)
Notreported.Increasing oftympanic
temperature:continuous andintermittent (p<0.05)
Landgrebeetal.(PLoS One2009)
Case-control n=196 (Germany)
n=35(patients withEMH)n = 14controls
EMHn=69,controls
n=80
Ordinaryenvironmental exposuretoEMRFR
Nodirectassociation; higherincidenceof tinnitusamongpatients withEMH(p<0.0001)
Mandalàetal. (Laryngoscope2014)
Randomizedtrial n=12 (Italy)
Allparticipants wereaffectedby unilateraldefinite Ménière’sdisease
Notreported Allpatientsunderwent retrosigmoidvestibular neurectomywhilebeing monitoredtoevaluate directmobilephone exposure/effectsof Bluetoothheadsets
Noshort-termeffectsof BluetoothEMRonthe auditorynervous structures;Directmobile phoneEMRexposure confirmedasignificant decreaseinamplitude andanincreasein latencyofevoked cochlearnerveaction potentials
Freietal.(EnvironInt 2012)
Cohort n=1375
(Switzer-land)
n=7Statistically significant developedtinnitus outof144risk estimates
EMHinaquestionnaire: no:825,yes:294,don’t know:256
Evaluationoffarfields (residentialexposureto fixedsitetransmitters); nearfields(mobileand cordlessphone)
Theroleofelectromagneticradiofrequencyradiation 101
T
able
1
(
Continued
)
Authors,
Journal,
Year
Study
design
P
atients
(
n
)
P
resence
of
tinnitus
P
resence
of
EMH
Exposure
to
EMRFR
Association tinnitus-EMRFR
Landgrebe
et
al.
(Psychol
Med
2008)
Case-control
n
=
196
(Germany)
Not
reported
n
=
89
Ordinary
environmental
exposure
to
EMR-RF
transcranial
magnetic
stimulation
of
all
patients
Not
reported.
Significant
cognitive
and
neurobiological alterations
on
TMS:
vulnerability
of
electromagnetic hypersensitive
patients
EMH,
electromagnetic
hypersensitivity;
EMRFR,
electromagnetic
radiofrequency
radiation;
n
,
number;
OR,
odds
ratio;
CI,
confidence
interval;
TMS,
transcranial
magnetic
stimulation.
• As a medical condition based on the interpretation of the patients about their condition, independent of any establishedcausalrelationship.
EMH has been better detailed in European and Scan-dinavian countries, and it has been widely reported on themedia.36 ItisalreadyacceptedthatEMHcausesmajor impactonqualityoflife,increaseduseofhealthcare,and psychosocialdisorders,37 in addition toreduction of work capacity,unemployment,andearlyretirementin Scandina-viancountries.38 Thus,someindividualsalreadyareaware toavoid exposure toEMRas muchaspossible.35 It is the authors’opinionthat,asinmanyotherhealthissues, devel-opingcountriessuchasBrazilwouldbenefitbyfollowingthe stepsofdevelopedcountries.
AlthoughEMHhasbeenrelatedtoindividual characteris-ticsandnottoamandatoryvariableofexposuretoEMRFR, thereisalreadyevidenceoftheinfluenceofEMRFRin cog-nitivefunctionandneuralprocessingintheauditorycentral cortex.39 It is suspected that EMH can be manifested as cognitivedysfunction,with reduceddiscriminationby the sensorysystemandincreasedcorticalactivationinthe ante-riorcingulategyrusandinsula.40Ifthishypothesisiscorrect, auditoryinvolvementwouldhaveacausalbasis.
Tinnitus has been reported as one of the symptoms in patients with EMH.37 In a case-control study involving 89patientswithEMHand107controlsmatchedbysex,age, andexposuretocommonsourcesofEMRFR,tinnitus preva-lencewassignificantlyhigherinpatientswithEMH(50.72% vs.17.5%).17
From this standpoint, it has been attempted to find factorsthatcorroboratetherelationship betweentinnitus andEMH. Onefactorrepeatedlyobservedin patientswith EMH is reduction in the ability to discriminate magnetic pulses, which had already been identified as a predictor oftinnitus.41Furthermore,tinnitusandEMHseemtoshare similaritiesinpathophysiologyrelatedtosensory discrimi-nation.
Another common point is the vulnerability of patients withEMHtodistressagents,affecting theautonomic ner-voussystem(ANS).42ThestateofANShyperexcitabilitymay bemediatedbychangesincorticalglutamatergicreceptors, whichcanberesponsiblefor adecreased adaptive capac-ityintheseindividuals.43Besidesthis,ANShyperexcitability duringtheonsetandworseningoftinnitusiswellknown.44
However, despite the significantly greater occurrence oftinnitusinpatients withEMH,Landgrebe etal.17 found noassociationbetweentinnitusandindividualexposureto EMRFR, suggesting that this exposure does not appear to cause tinnitus directly. This finding can be countered by other evidence,though. It has been shown that intensive useofcellphoneanduseforprolongedperiods(≥4years) areassociatedwith tinnitus,45 suggesting that this device shouldbestudied asa potentialrisk factor.Furthermore, asthe prevalence of tinnitus hasbeen rising worldwide,2 importanceof environmental factors in tinnitus inception shouldbeconsidered.
Discussion
academiccentersandtheincreasingavailabilityofscientific journalshavecontributedtotheglobalizationofexpertise. However,only asmallportion of publishedscientific arti-clesreachalevelofevidencesufficientlyconvincingtomost researchers.
In the present study,although theauthors found little statisticallysignificant evidenceoftheinfluenceofEMRFR ontinnitus,theassociationbetweentheseconditionsshould notbeneglected,either.
The main studies that evaluated tinnitus, exposure to EMRFR,andpresenceofEMHarecomparedonTable1.
Evenso,theadvanceofrigorousscienceitselfhasshown thatwell-establishedopinionschangeovertimeasnewdata areincorporatedintotheresearch.Itiswidelyacceptedthat evidence-basedmedicineshould inspireandguide profes-sionalconduct.However,theoppositeisalsotrue:anecdotal casesseen inthedaily routineshouldalsoinspirescience to deepen knowledge and confirm the existence or the reproducibilityofthefacts,considering thatmanystudies areneeded toformcriticalopinions.Publications of case reports,forexample,areundervaluedbythescientific com-munity,butstillhaveanimportantroletowarnaboutfacts thatcouldbewidelyacceptedlater.
Withthisin mind,for yearstheauthorshave observed patients with tinnitus considered idiopathic, even after investigatingmultiple etiologies listed in themedicaland audiological protocol. Emphasizing the suspicion of the patients,theauthorsincludedthequestionsaboutexposure tonon-ionizingradiofrequencyelectromagneticradiationin thediagnosticroutine:
1. Vicinity(residenceorbusiness)totowers,antennas,and transmissionlines
2. Useofthecellphoneforcalls: • Approximatedailytimeofuse
• Typeofnormaluse:directcontactwiththeear, head-set,orBluetooth
• Preferentialuseinoneoftheears
Adoptingtheseextradata,itwaseasier tosuspectthe influenceofEMRFR ontinnitusduetofrequent cellphone use,especiallyincasesofprolongeduse,withthepreferred earcoinciding with the presence of unilateral (or worse) tinnitus. These are the patients whomight be more vul-nerabletohave electromagnetichypersensitivity(EMH) or electrosensitivity.
Theperipheralauditorypathwayhastheabilityto cap-turesoundwavesfromtheenvironmentandtransmitthem activelytothecortex.SinceEMRFRalsopresentsdiverse fre-quencies(startingat3kHz)andamplitudes,similartothat whichoccurswithsoundwaves,itisplausibletoacceptthat certainfrequencies andamplitudes ofEMRFR can be cap-turedby theperipheralauditorysystem.Valid comparison ismadetoskin,anothersenseorgan,responsible for cap-turingthermal,tactile,andpainfulsensations,whichcanbe highlyaffectedbyinfraredradiation.
Although cell phone manufacturers ensure that their use is safe, the World Health Organization has classified radiofrequencyelectromagneticradiationasapotential car-cinogen (class 2B), the same classification used for lead, chloroform, and emissions from automobiles. This war-ning was based on the analysis of studies performed by
Table2 Suggestionsforsafeuseofcellphones,according totheUniversityofPittsburghCancerCenter,2008.
Practicaladvicetolimitexposuretoelectromagnetic radiationemittedfromcellphones
Donotallowchildrentouseacellphone,exceptfor emergencies.Thedevelopingorgansarethemostlikely tobesensitivetoanypossibleeffectsofexposureto electromagneticfields.
Keepthecellphoneawayfromthebodyasmuchas possible.Theamplitudeoftheelectromagneticfield decreasesasitmovesawayfromtheradiationsource. Wheneverpossible,useofthespeaker-phonemode, wirelessBluetoothheadset,orhands-freeheadsetthat mayalsoreduceexposures.
Avoidusingacellphoneinpublicplaceswhereyoucan passivelyexposeotherstothephone’selectromagnetic fields,likeabusorsubway.
Avoidcarryingacellphoneclosetothebodyatalltimes. Donotkeepitnearyourbodyatnight,particularlyif pregnant.Youcanalsoputiton‘‘flight’’or‘‘off-line’’ mode,whichstopselectromagneticemissions.
Ifyoumustcarryyourcellphoneonyou,itispreferable thatthekeypadispositionedtowardyourbodyandthe backispositionedtowardtheoutsideofyourbody. Dependingonthethicknessofthephone,thismay provideaminimalreductionofexposure.
Conversationsshouldlastforfewminutes,asthebiological effectsaredirectlyrelatedtothedurationofexposure. Forlongerconversations,usealandlinewithacorded phone,notacordlessphone,whichuseselectromagnetic emittingtechnologysimilartothatofcellphones.
Switchsidesregularlywhilecommunicatingoncellphone tospreadoutyourexposure.Beforeputtingyourcell phonetotheear,waituntilyourcorrespondenthas pickedup.
Avoidusingyourcellphonewhenthesignalisweakor whenmovingathighspeed,suchasinacarortrain,as thisautomaticallyincreasespowertoamaximumasthe phonerepeatedlyattemptstoconnecttoanewrelay antenna.
Whenpossible,communicateviatextmessagingrather thanmakingacall,limitingthedurationofexposureand theproximitytothebody.
Chooseadevicewiththelowestspecificabsorptionrate (SAR)possible.SARratingsofcontemporaryphonesare availablefrommanufacturers.
30researchersfrom14countries,whichsuggestincreased riskofgliomasandneuromasincellphoneusers.46
Theroleofelectromagneticradiofrequencyradiation 103
EMH is a predisposing factor for the worsening of tinni-tus,orwhetherbothshareasimilarpathophysiologyisstill under discussion.17 Prospective cohort studies will define morepreciselyiftheriskofonsetoftinnitusishigherincell phoneusersorthosewithothersourcesofradiofrequency exposure.
Inthehistoryofscience,alongtimeisoftennecessary togatherenoughconclusivestudiestosupportopinionson the exposurefactor and risk ofdisease, i.e.,as currently accepted ontobacco’s effectupon various organs. As the cellphonehasledtoagreatadvanceincommunicationin modernsocieties,andshouldremainso,theauthors recom-mend the conduct ofcommon sense relatedtoits usage. PracticalsuggestionshavebeenpublishedbytheUniversity ofPittsburghCancerInstitute47(Table2).
Conclusion
This studycollectedevidencefor theassociationbetween exposuretoEMRFRandtinnitusinsome patients, particu-larlythosesufferingfromelectromagnetichypersensitivity. Whileitisnotfullyconfirmed,theauthorsconsiderit appro-priate to direct more attention to cell phone use in the diagnosticinvestigationofpatientswithhearingdisorders, especiallytinnitus.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
Acknowledgements
The authors would like tothank the librarian Mr. Adilson Montefusco andinparticular Mr.SoterMarcello Correada Silveiraforthevastmaterialprovided.
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