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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 432-439

Mobile phone use and its risk on hearing


1 Department of Otolaryngology, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
2 Department of Public Health and Community Medicine, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
3 Department of Public Health and Community Medicine, Kafr El-Sheikh Health Sector, Egypt

Date of Submission20-Oct-2013
Date of Acceptance02-Feb-2014
Date of Web Publication26-Sep-2014

Correspondence Address:
Lamiaa Mohamed Abd El Hady
MBBCh, 8-El Moalmeen Street, Sector-2, Kafr El-Sheikh City, Kafr El-Sheikh Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141723

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  Abstract 

Objectives
The aim of this study was to assess the potential changes in human hearing function as a consequence of exposure to electromagnetic fields produced by mobile phones through a review of in-vivo and in-vitro published studies.
Data sources
Medline databases (PubMed, Medscape, ScienceDirect and EMF-Portal) and all materials available in the internet from 2003 to 2012.
Study selection
The initial search presented 170 articles, of which 44 met the inclusion criteria. The articles studied the relation between mobile phones, the auditory system and genotoxicity.
Data extraction
If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was obtained, whether the eligibility criteria were specified, and whether appropriate controls, adequate information and defined assessment measures were included.
Data synthesis
Comparisons were made by a structured review with the results tabulated.
Findings
In total, 44 potentially relevant publications were included: 32 were human and 12 were animal studies. The studies do not indicate an association between any problem related to the auditory system and short-term exposure of mobile phone radiations, whereas long-term use of mobile phones may lead to high-frequency hearing loss. Studies concerning mobile phone radiation and the risk of acoustic neuroma have controversial results. Some authors did not notice evidences of a higher risk of tumour development in mobile phone users, whereas others report that usage of analog cellular phones for 10 or more years increases the risk of developing the tumour.
Conclusion
We found no overall increased risk of hearing problems among short-term cellular phone users, whereas long-term use of mobile phones may lead to high-frequency hearing loss and an increased risk of acoustic neuroma after 10 years of mobile phone use. The potential elevated risk of brain tumours after long-term cellular phone use awaits confirmation by future studies

Keywords: Acoustic neuroma, electromagnetic fields, hearing, mobile phone


How to cite this article:
Ragab A, Salem ME, Abd El Hady LM. Mobile phone use and its risk on hearing. Menoufia Med J 2014;27:432-9

How to cite this URL:
Ragab A, Salem ME, Abd El Hady LM. Mobile phone use and its risk on hearing. Menoufia Med J [serial online] 2014 [cited 2019 Dec 7];27:432-9. Available from: http://www.mmj.eg.net/text.asp?2014/27/2/432/141723


  Introduction Top


The use of mobile phones has drastically increased all over the world during 1990s. During the decade, mobile phone use increased to almost 100% prevalence in many countries of the world [1]. Mobile phones have become an increasingly widespread means of communication that communicate by transmitting radio waves through a network of fixed antennas called base stations [Figure 1]. They have become a part of everyday life, with a growing number of people enjoying the service and extra freedom they provide. In some parts of the world, mobile phones are the most reliable or the only phones available. Mobile phone use has proven to be life saving in certain circumstances (e.g. after accidents) and has helped improve the quality of life in some sectors. At the end of 2012, there were 6.8 billion mobile subscriptions, as estimated by the International Telecommunication Union (ITU) (February 2013). That is equivalent to 96% of the world population (7.1 billion according to the ITU) [Figure 2], and is a huge increase from the 6.0 billion mobile subscribers in 2011 and the 5.4 billion in 2010. This has given rise to concerns about potential influences of the electromagnetic field (EMF) emitted by mobile phones and its spectrum [Figure 3] on health. Although there is no clear evidence to demonstrate harmful physiological effects of EMFs at the levels used by mobile phones, there is a widespread public concern that there may be some potential harm [2].
Figure 1:

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Figure 3:

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{Figure 3}

Because of this widespread use of the Global System for Mobile Communications (GSM) mobile phones, they have become indispensable as communication tools and therefore any consequent biological effects should be considered as a high-priority environmental health issue. However, to date, there is inadequate knowledge on what biological systems could be affected by the use of these devices. Biological effects of radiofrequency (RF) EMFs transmitted by mobile phones are still a matter of public and scientific discussion. Sensations of burning or warmth around the ear, headache [3], disturbance of sleep, restlessness, concentration and memory problems, absence of appetite, tinnitus [4], alteration of cognitive functions and neural activity as well as alteration of the blood-brain barrier and a relative decrease in regional cerebral blood flow have been reported as effects resulting from mobile phone use. The potential tumorous effect of EMFs is still a subject of debates and research [5].

The hearing system is in the closest proximity to the device, and so hearing is potentially the most affected target of thermal and nonthermal effects. Moreover, the hearing system and particularly the cochlear outer hair cells are known to be highly sensitive to a considerable variety of exogenous and endogenous agents, and externally applied electric and magnetic fields are known to be able to produce some hearing sensation [6].

A large number of studies have been performed over the last two decades to assess whether mobile phones pose a potential health risk. To date, no adverse health effects have been established for mobile phone use [7]. In fact, the only evidence for their conclusions was variations in hearing loss among mobile phone users. There is no shame in reporting a null or very weak result. It is reported that exposure to mobile phones does not cause measurable effects on the human auditory system [8]. Also, a substantial number of epidemiological studies on the possible link between mobile phone use and an increased brain tumour risk have been published, but no clear positive association has been found. Some uncertainty, however, still remains, particularly regarding long-term effects of mobile phone use (≥15 years) [9].

The small amount of publications regarding the auditory system shows that there is a big gap in the knowledge of potential biological effects of cellular phone use on hearing. Hence, the present study aims to assess the potential changes in human hearing function as a consequence of exposure to EMFs produced by mobile phones.

It also aims to collect and critically review the most recent results from laboratory studies on the effects of EMFs on both cancer and noncancer endpoints of the auditory system, and to provide information relevant for formulating policies on nonionizing radiation protection and advice for the development of policy options by stakeholders such as regulatory bodies, industries and consumer associations. It provides an update on the general status of in-vitro and in-vivo laboratory studies and describes recent studies in brief.


  Materials and methods Top


Search strategy

We reviewed papers on the influence of mobile phones on the auditory system from Medline databases (PubMed, Medscape, ScienceDirect) and also materials available on the internet. We used mobile/cellular/cordless telephone and brain tumour/neoplasm/acoustic neuroma/auditory system/hearing loss as searching terms. In addition, we examined references from the specialist databases EMF-Portal (http://www.emf-portal.de), reference lists in relevant publications and published reports from national EMF and mobile phone research programmes. The search was performed in the electronic databases from 2003 to 2012.

Study selection

All the studies were independently assessed for inclusion. They were included if they fulfilled the following criteria:

  1. Published in English language.
  2. Published in peer-reviewed journals.
  3. Focused on exposure to mobile phone radiations.
  4. Discussed the relation between mobile phones, the auditory system and genotoxicity.
  5. If a study had several publications on certain aspects, we used the latest publication giving the most relevant data.


Data extraction

Studies that did not fulfill the above criteria, such as studies on mobile phone base stations or other exposures without mobile phones, surveys about symptoms and health concerns without exposure assessment, reports without peer-review, studies that were not within the national research programme, letters/comments/editorials/news and studies not focused on exposure from mobile phone, were excluded.

The publications analysed were evaluated according to evidence-based medicine (EBM) criteria using the classification of the US Preventive Services Task Force and UK National Health Service protocol for EBM in addition to the Evidence Pyramid [Figure 4].
Figure 4:

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US Preventive Services Task Force:

  1. Level I: Evidence obtained from at least one properly designed randomized controlled trial.
  2. Level II-1: Evidence obtained from well-designed controlled trials without randomization.
  3. Level II-2: Evidence obtained from a well-designed cohort or case-control analytic studies, preferably from more than one centre or research group.
  4. Level II-3: Evidence obtained from multiple time series with or without intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
  5. Level III: Opinions of respected authorities, on the basis of clinical experience, descriptive studies or reports of expert committees.


Quality assessment

The quality of all the studies was assessed. Important factors included the study design, attainment of ethical approval, evidence of a power calculation, specified eligibility criteria, appropriate controls, adequate information and specified assessment measures. It was expected that confounding factors would be reported and controlled for and appropriate data analyses made in addition to an explanation of missing data.

Data synthesis

A structured systematic review was performed with the results tabulated.


  Results Top


Study selection and characteristics

In total, 170 potentially relevant publications were identified: 126 articles were excluded as they did not meet our inclusion criteria. A total of 44 studies were included in the review as they were deemed eligible by fulfilling the inclusion criteria. Of these 44 articles, included in this review, 32 were human studies and 12 were animal studies. The majority of the studies examined the effects of mobile phone radiations on the central and the peripheral auditory organs, the risk of acoustic neuroma with mobile phone use and other effects. Some studies examined the genotoxic effect of RF radiation to the brain cells. The studies were analysed with respect to the study design using the classification of the US Preventive Services Task Force and UK National Health Service protocol for EBM.

Effects over peripheral hearing according to evidence-based medicine

The effects of electromagnetic radiations of mobile phones on the hearing function and the peripheral auditory system were investigated in eight animal and 11 human studies.

Seven studies of all eight animal studies [Table 1] [10],[12],[13],[18],[19],[20],[21] (which comes in the base of the Evidence Pyramid and provides the least strength of evidence) investigating the exposure of animals (rats and guinea pigs) to EMF found that exposure to EMF emitting from a mobile phone for 30 days did not cause any hearing deterioration at least at outer-ear and middle-ear and cochlear levels. Only one study[11] found that extremely low-frequency EMF might affect the hearing function and cochlear activity.
Table 1: Animal studies investigating the effects of electromagnetic radiations of mobile phones on the hearing function and the peripheral auditory system

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Regarding human studies [Table 2], there was one randomized, case-control study [14] that comes in level I (or level A) EBM and two cohort studies [15],[16] with level II-2 (or level A) EBM assessing the chronic effects of exposure to EMF of mobile phones on the hearing level, and they reported that long-term (more than 1 year) and intensive mobile phone use may cause inner-ear damage, high-frequency loss and absent DPOAEs with an increase in the duration of mobile phone use. Of seven case-control studies with level II-2 (or level B) EBM, five studies [6],[8],[23],[24],[25] reported that there was no effect of short-term exposure to GSM and UMTS mobile phone signals on the main measures of the status of the auditory system, whereas the other two studies [17],[22] reported that a higher degree of hearing loss is associated with long-term exposure to EMF generated by cellular phones.
Table 2: Human studies investigating the effects of electromagnetic radiations of mobile phones on the hearing function and the peripheral auditory system

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Effects over central hearing according to evidence-based medicine

We identified two human trials [Table 3] that investigated the effects of mobile phones on the human central hearing system and the human ABR. One of them is a cohort study [16] with level II-2 (or level A) EBM, which showed that long-term use of mobile phones may cause damage to the cochlea as well as the auditory cortex, whereas the other study was a double-blind case-control study [27] with level II-2 (or level B) EBM, which found no measurable effects and no alteration in the human auditory brainstem response with short-term exposure. Also, one animal study [28] investigated the possible electrophysiological changes in the auditory pathway and the central auditory system, which showed that exposure to EMFs emitted by mobile phones can affect the activity of the auditory system in rabbits.
Table 3: Effects over central hearing according to evidence-based medicine

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Effects over vestibular system according to evidence-based medicine

The influence of mobile phones on the vestibular system was investigated in three studies [Table 4]: A double-blind case-control study [24], a systemic review [26] and an experimental in-vitro study [29]. They all showed no immediate effects on vestibulocochlear function with short-term exposure to mobile phone.
Table 4: Effects over the vestibular system according to evidence-based medicine

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Oncological effects over neural and brain tissues (acoustic neuroma) according to evidence-based medicine

We identified 11 human studies that investigated a possible association between the use of mobile phones and the development of acoustic neuroma. Of these trials, we identified four randomized case-control studies with level I (or level A) EBM. None of these trials revealed an increased risk of acoustic neuroma related to mobile phone use. However, one of them suggested an increased risk of acoustic neuroma associated with mobile phone use of at least 10 years' duration. Six case-control studies were also identified, of which four of them did not indicate significant increase in the risk of AN in association with mobile phone use, but the other two studies found that there is possible evidence linking mobile phone use to an increased risk of acoustic neuroma.

Also, one nationwide cohort study including 2.9 million participants was identified. This study estimated the risk of AN and investigated the laterality of the tumour and its size among long-term mobile phone users; this study did not support the hypothesis that the use of a mobile phone increases the risk of AN.

Three additional meta-analyses and two systemic reviews were identified. Two meta-analyses and one systemic review found that the use of mobile phones for at least 10 years yielded a consistent pattern of increased risk for acoustic neuroma. The risk is the highest for ipsilateral exposure, whereas the other meta-analysis and systemic review showed no significant increase in the risk for head tumours (acoustic neuroma) from mobile phone use, and it also showed no significant relationship between exposure to RF fields and genotoxic damage to brain cells.

Effects over the auditory system with tinnitus generation

We identified one randomized case-control study [Table 5] [30] and one prospective cohort study [31] that investigated the association between RF-EMF exposure and tinnitus. When the data were considered together, it was found that there is no association between RF-EMF exposure and tinnitus, but they recommend that mobile phone use should be included in future investigations as a potential risk factor for developing tinnitus.
Table 5: Effects over the auditory system with tinnitus generation according to evidence-based medicine

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Effects over genes (genotoxicity)

We identified three animal studies and one meta-analysis investigating the genotoxicity of long-term exposure to RF-EMFs evaluating possible carcinogenic effects of RF fields. The three animal studies excluded any RF-induced genotoxicity in exposed animals. Also, the meta-analysis excluded any significant increase in genetic damage to human cells exposed to RF considering it is not carcinogenic to humans.


  Discussion Top


Research on the health implications of exposure to EMFs is an area in which there are a significant number of scientific studies underway within both national and international research programmes, in both public and private laboratories, and as a result of the activities of standards and regulatory bodies. These studies cover the whole of the EMF spectrum from extremely low to terahertz frequencies and include different signal modulations. Both in-vitro and in-vivo exposures are being conducted using cells, animals and humans, as well as clinical and epidemiological investigations, including studies measuring the actual exposure of both members of the public and workers in occupational settings. However, because of the volume of data being generated, it can be very difficult to provide relevant and timely inputs for the development of policies on EMF and health issues. This can result in the misinterpretation of results or in the inappropriate extrapolation of scientific findings. Hence, this study tried to provide an update on the general status, describe recent studies in brief, and classify and evaluate them according to EBM criteria.

A review of recent studies on the possible effects of mobile phone signals on the auditory system found that mobile phone use can affect the hearing function of users according to the duration of use.

Short-term exposure at the maximum output of consumer mobile phones does not cause measurable immediate effects on the human auditory system, whereas long-term (more than 1 year) and intensive mobile phone use may cause inner-ear damage and can lead to high-frequency hearing loss.

Some epidemiological studies on mobile phone use have suggested an increased risk of acoustic neuroma, but others have not. Studies to date have been conflicting about its possibility with mobile phone use. Inconsistent results have been published on the potential risk of brain tumours associated with mobile phone use as a result of important methodological differences in the study design and the statistical power. Some studies have examined mobile phone users for periods of time that are too short to detect an increased risk of brain cancer, whereas others have misclassified exposures by placing those with exposures to microwave radiation from cordless phones in the control group or by failing to attribute such exposures in the cases [32]. There is also potential bias because acoustic neuroma is a very slow-growing tumour and symptoms of the tumour, in particular hearing loss, experienced long before diagnosis could have influenced individuals' behaviours regarding phone use [33].

On 31 May 2011, the International Agency for Research on Cancer (IARC) of the WHO issued a press release announcing that it had classified and added cell phone radiation to its list of physical agents that are 'possibly carcinogenic to humans' (group 2B agents). Other group 2B agents include coffee, pickled vegetables and lead. This classification was made after a working group of 31 scientists finished a review of previously published studies and found 'limited evidence of carcinogenicity' from the RF-EMFs emitted by wireless phones, radio, television and radar.

In one type of study (a case-control study), cell phone use was compared between people with these types of tumours and people without them. In another type of study (a cohort study), a large group of people was followed over time, and the rate of these tumours in people who did and did not use cell phones was compared. The results of these studies have generally not provided clear evidence of a relationship between cell phone use and cancer, but there have been some statistically significant findings in certain subgroups of people.

In the present analyses, there is some risk for reported mobile phone use for 10 or more years ipsilateral to the tumour, but risks were not increased for shorter durations of ipsilateral use. There is no consistent biological evidence that exposure to RF fields is implicated in the development of tumours, nor has a potential aetiological mechanism been demonstrated. Overall, there is no convincing epidemiological evidence that RF exposure is related to neoplasia. It is, however, clear that a lack of available evidence of cancer with regard to the use of mobile phone should not be interpreted as proof of absence of cancer risk, and that excessive use of mobile phones should be taken very seriously and with caution to prevent cancer [34]. Thus, on balance, the evidence suggests that there is no substantial risk of acoustic neuroma in the first decade of use, but there is a possibility of some effect after longer periods of use.

Mobile phones are still a new technology, and there is little evidence about effects of long-term use. Given the absence of definitive proof in humans of the carcinogenic effects of EMFs of cell phones, we cannot speak about the necessity of preventative measures (as for tobacco). In anticipation of more definitive data covering prolonged periods of observation, the existing data press us to share important prudent and simple measures of precaution for cell phone users [35].

In addition to using 'hands-free' devices, which keep mobile phones away from the head and body during phone calls, exposure is also reduced by limiting the number and the length of calls. Using the phone in areas of good reception also decreases exposure as it allows the phone to transmit at reduced power.


  Conclusion Top


This review does not indicate an association between any problem related to the peripheral auditory system and hearing function with short-term exposure to EMR of mobile phones; whereas long-term exposure and frequent mobile phone use may be correlated with a degree of hearing loss.

Regarding the central auditory system and acoustic neuroma, mobile phones may cause damage to the cochlea and the auditory cortex with long-term use, with an increased risk of acoustic neuroma after 10 years of mobile phone use.

There are no immediate effects on the vestibulocochlear function and tinnitus with short-term exposure to mobile phone.

The study excluded any significant increase in genetic damage to human cells exposed to RF considering it is not carcinogenic to humans.

For long-term effects, the evidence for the absence is limited. Moreover, very little information on effects in children and adolescents is available, and the question of the potential risk of these age groups remains unresolved. Hence, further research applying a longitudinal design should focus on the long-term effects and should include children and adolescents.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.[36]

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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