Exposure to non-ionizing electromagnetic fields emitted from mobile phones induced DNA damage in human ear canal hair follicle cells

The aim of this study was to investigate effect of radiofrequency radiation (RFR) emitted from mobile phones on DNA damage in follicle cells of hair in the ear canal. The study was carried out on 56 men (age range: 30–60 years old)in four treatment groups with n = 14 in each group. The groups were defined as follows: people who did not use a mobile phone (Control), people use mobile phones for 0–30 min/day (second group), people use mobile phones for 30–60 min/day (third group) and people use mobile phones for more than 60 min/day (fourth group). Ear canal hair follicle cells taken from the subjects were analyzed by the Comet Assay to determine DNA damages. The Comet Assay parameters measured were head length, tail length, comet length, percentage of head DNA, tail DNA percentage, tail moment, and Olive tail moment. Results of the study showed that DNA damage indicators were higher in the RFR exposure groups than in the control subjects. In addition, DNA damage increased with the daily duration of exposure. In conclusion, RFR emitted from mobile phones has a potential to produce DNA damage in follicle cells of hair in the ear canal. Therefore, mobile phone users have to pay more attention when using wireless phones.     

Hypersensitivity symptoms associated with exposure to cellular telephones: no causal link

The hypothesis that there exist hypersensitive persons who perceive subjective symptoms from radiofrequency (RF) fields emitted by hand held mobile phones (cellular phones) was tested using double blind provocation experiments. We also tested whether sensitive subjects are able to determine whether the phone is on or off by sensing RF fields. The study group consisted of 20 volunteers (13 women and 7 men) who reported themselves as being sensitive to cellular phones. The RF exposure sources were one analogue NMT phone (900 MHz) and two digital GSM phones (900 and 1800 MHz). The duration of a test session was 30 min, and three or four sessions were performed in random order for each subject during 1 day. The subjects were asked to report symptoms or sensations as soon as they perceived any abnormal feelings. In addition, the subjects' blood pressure, heart rate, and breathing frequency were monitored every 5 min. The results of the study indicated that various symptoms were reported, and most of them appeared in the head region. However, the number of reported symptoms was higher during sham exposure than during real exposure conditions. In addition, none of the test persons could distinguish real RF exposure from sham exposure. Hence, we conclude that adverse subjective symptoms or sensations, though unquestionably perceived by the test subjects, were not produced by cellular phones.     

Whole body exposure of rats to microwaves emitted from a cell phone does not affect the testes

The objective of this study was to investigate the effects of radiofrequency radiation emitted from cellular phones on the lipid composition, malondialdehyde concentration, p53 immune reactivity, sperm count, morphology, histological structure of testes, and on rectal temperature of rats exposed to microwave radiation emitted from cellular phones. Sixteen Spraque-Dawley rats were separated into two groups of eight, sham exposed (control) and experimental. The rats were confined in plexiglas cages specially designed for this study, and cellular phones were placed 0.5 cm under the cages. For the experimental group, cellular phones were activated 20 min per day (7 days a week) for 1 month. For the control group, the cellular phones were placed beneath the cages for 20 min a day, but the phones were turned off. Rectal temperatures were measured weekly. For 250 mW radiated power, the whole body average SAR (rms) is 0.52 W/kg and 1 g averaged peak SAR (rms) is 3.13 W/kg. The Mann-Whitney U-test was used for statistical comparisons of groups. No statistically significant alteration in any of the endpoints was noted. This study found no evidence suggesting an adverse effect of cell phone exposure on measures of testicular function or structure.     

Subjective and Clinically Assessed Hearing Loss; A Cross-Sectional Register-Based Study on a Swedish Population Aged 18 through 50 Years

Objectives

Questionnaire studies suggest that hearing is declining among young adults. However, few studies have examined the reliability of hearing questionnaires among young adult subjects. This study examined the associations between pure tone audiometrically assessed (PTA) hearing loss and questionnaire responses in young to middle aged adults.

Materials and Methods

A cross-sectional study using questionnaire and screening PTA (500 through 6000 Hz) data from 15322 Swedish subjects (62% women) aged 18 through 50 years. PTA hearing loss was defined as a hearing threshold above 20 dB in both ears at one or more frequencies. Data were analysed with chi-square tests, nonlinear regression, binary logistic regression, and the generalized estimating equation (GEE) approach.

Results

The prevalence of PTA hearing loss was 6.0% in men and 2.9% in women (p < 0.001). Slight hearing impairment was reported by 18.5% of the men and 14.8% of the women (p < 0.001), whereas 0.5% of men and women reported very impaired hearing. Using multivariate GEE modelling, the odds ratio of PTA hearing loss was 30.4 (95% CI, 12.7-72.9) in men and 36.5 (17.2-77.3) in women reporting very impaired hearing. The corresponding figures in those reporting slightly impaired hearing were 7.06 (5.25-9.49) in men and 8.99 (6.38-12.7) in women. These values depended on the sound stimulus frequency (p = 0.001). The area under the ROC curve was 0.904 (0.892-0.915) in men and 0.886 (0.872-0.900) in women.

Conclusions

Subjective hearing impairment predicted clinically assessed hearing loss, suggesting that there is cause for concern as regards the future development of hearing in young to middle-aged people.     

Estimation of relative exposure levels for cellular phone users using a neural network

The wide and growing use of cellular phones has raised questions about the possible health risks associated with radio frequency (RF) electromagnetic fields. It would be helpful for epidemiologists as well as cellular phone users to obtain the relative exposure levels, because the RF exposure level is very difficult to accurately measure and quantify for all individuals. In this study, a neural network model was developed to estimate relative exposure levels on a scale of 0-10 and thus rank the individual risk of exposure using available information. We used parameters such as usage time per day, total usage period, hands-free usage, extension of antenna, specific absorption rate (SAR) of the cellular phone, and flip or folder type, which are related to RF exposure. Using the relative exposure levels obtained from this model, epidemiologists can divide the subjects into exposed and nonexposed groups in a study investigating the relationship between exposure level and brain cancer in the future, provided that more knowledge between the cellular phone usage pattern and the exposure is available.     

The Effects of Whole Body Cell Phone Exposure on the T1 Relaxation Times and Trace Elements in the Serum of Rats

The objective of this study was to investigate the effects of radiofrequency radiation emitted from cellular phones on: (1) trace elements such as manganese, iron, copper, zinc, (2) T1 relaxation times in serum, and (3) rectal temperature of rats exposed to microwave radiation emitted from cellular phones. Sixteen Spraque–Dawley rats were separated into two groups of eight, one sham-exposed (control) and one exposed (experimental). The rats were confined in Plexiglas cages and a cellular phone was placed 0.5 cm under the cage. For the experimental group, cellular phones were activated 20 min per day, 7 days a week, for 1 month. For the control group, a cellular phone placed beneath the cage for 20 min a day was turned off. Rectal temperatures were measured weekly. For 250-mW-radiated powers, the whole body average specified absorption rate (SAR) (rms) is 0.52 W/kg and 1-g-averaged peak SAR (rms) is 3.13 W/kg. The Mann-Whitney U test was used for statistical comparisons of groups. T1 relaxation time and the values of iron and copper in the serum of the experimental group were not changed compared to the control group (p > 0.05). However, manganese and zinc values in the serum of the experimental group were significantly different from the control group (p < 0.05). The difference in rectal temperature measured before and after exposure in the experimental groups was not statistically different from control (p > 0.05).     

Does 900 MHZ GSM Mobile Phone Exposure Affect Rat Brain?

This study investigated the effects of cell phone exposure on the fatty acid composition in phospholipids, malondialdehyde concentration, p53 immune reactivity and histological structure of the rat brain. Sixteen Sprague-Dawley rats were divided into two groups of eight, sham and experimental (speech conditions). The rats were confined to Plexiglas cages, and cellular phone were placed 0.5 cm under the cages. For the experimental group, cellular phones were activated 20 minutes per day, 7 days a week, for 1 month. For the sham group, the cellular phones were placed beneath the cages with the phones turned off. The Whole Body Average SAR (rms) was 0.52 W/kg and 1 g averaged peak SAR (rms) 3.13 W/kg. The Mann-Whitney U-test was used for statistical comparisons of groups. Histological alteration and changes in brain phospholipid fatty acids composition were not observed in rat brains. Immunohistochemical staining of brain tissue shown that p53 immunoreactivity was not affected by cell phone exposure. Malondialdehyde concentration in exposed brains was significantly higher than sham (p < 0.05).     

Evoked acoustic oto-emissions in cochlear deafness]

In order to give a contribution to the genesis of the EOAEs, we have recorded echos in 24 subjects with unilateral sudden deafness (I. group); 20 ears with Menière disease (II. group); 22 ears with progressive sensorineural hearing loss (III. group) and 10 normally hearing young subjects as control group. The results have shown that the EOAEs were present in 100% (I. group), 84.6% (II. group) and 86.3% (III. group) in response to the tone-burst; while the echos were present only in the 57.1% (I. group), 38.4% (II. group) and 45.4% (III. group) in response to the click, although the audiometric threshold mean were greater than 45 dB HL for 2-4 KHz and 1 KHz in the three experimental groups except for 2-4 KHz in the subjects with Menière disease (37.5 dB HL). The properties of EOAEs (detection and saturation threshold, dynamic range and duration) depended on the degree of hearing loss. Our results seem to corroborate the hypothesis that EOAEs could be also produced by a passive intracochlear mechanism attributable to the travelling wave of the basilar membrane provoked by the perilymph. In the normal ear this passive mechanism could be superimposed by an active mechanism, linked to the contractile activity of the outer hair cells with a consequent increase in amplitude of the EOAEs for the same stimulus intensity.     

Effects of RF exposure of teenagers and adults by CDMA cellular phones

Many cellular phone provocation studies have been conducted since the question of increased health risk from extended usage of cellular phones became a social issue. Internationally, most studies have been conducted regarding the effects of GSM cellular phones on blood pressure and heart rate of adult volunteers. On the other hand, very few provocation studies have been conducted regarding the physiological effects of CDMA phones on teenagers. In this study, two volunteer groups consisting of 21 teenagers and 21 adults were exposed to 300 mW of radio frequency (RF) electromagnetic field emitted by a CDMA cellular phone for half an hour. Physiological parameters such as systolic and diastolic blood pressures, heart rate, respiration rate, and skin resistance were simultaneously measured. All the parameters for both groups were unaffected during the exposure except for decreased skin resistance of the teenager group (P < .0001). For the regrouped 23 male and 19 female subjects, all the parameters for both groups were unaffected during the exposure except for decreased skin resistance of the male subjects (P = .0026). Those resistances at 10 min after the terminated exposure returned to the resistances at rest regardless of the different groups of age and sex.     

Cortical Reorganisation during a 30-Week Tinnitus Treatment Program

Subjective tinnitus is characterised by the conscious perception of a phantom sound. Previous studies have shown that individuals with chronic tinnitus have disrupted sound-evoked cortical tonotopic maps, time-shifted evoked auditory responses, and altered oscillatory cortical activity. The main objectives of this study were to: (i) compare sound-evoked brain responses and cortical tonotopic maps in individuals with bilateral tinnitus and those without tinnitus; and (ii) investigate whether changes in these sound-evoked responses occur with amelioration of the tinnitus percept during a 30-week tinnitus treatment program. Magnetoencephalography (MEG) recordings of 12 bilateral tinnitus participants and 10 control normal-hearing subjects reporting no tinnitus were recorded at baseline, using 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz tones presented monaurally at 70 dBSPL through insert tube phones. For the tinnitus participants, MEG recordings were obtained at 5-, 10-, 20- and 30- week time points during tinnitus treatment. Results for the 500 Hz and 1000 Hz sources (where hearing thresholds were within normal limits for all participants) showed that the tinnitus participants had a significantly larger and more anteriorly located source strengths when compared to the non-tinnitus participants. During the 30-week tinnitus treatment, the participants’ 500 Hz and 1000 Hz source strengths remained higher than the non-tinnitus participants; however, the source locations shifted towards the direction recorded from the non-tinnitus control group. Further, in the left hemisphere, there was a time-shifted association between the trajectory of change of the individual’s objective (source strength and anterior-posterior source location) and subjective measures (using tinnitus reaction questionnaire, TRQ). The differences in source strength between the two groups suggest that individuals with tinnitus have enhanced central gain which is not significantly influenced by the tinnitus treatment, and may result from the hearing loss per se. On the other hand, the shifts in the tonotopic map towards the non-tinnitus participants’ source location suggests that the tinnitus treatment might reduce the disruptions in the map, presumably produced by the tinnitus percept directly or indirectly. Further, the similarity in the trajectory of change across the objective and subjective parameters after time-shifting the perceptual changes by 5 weeks suggests that during or following treatment, perceptual changes in the tinnitus percept may precede neurophysiological changes. Subgroup analyses conducted by magnitude of hearing loss suggest that there were no differences in the 500 Hz and 1000 Hz source strength amplitudes for the mild-moderate compared with the mild-severe hearing loss subgroup, although the mean source strength was consistently higher for the mild-severe subgroup. Further, the mild-severe subgroup had 500 Hz and 1000 Hz source locations located more anteriorly (i.e., more disrupted compared to the control group) compared to the mild-moderate group, although this was trending towards significance only for the 500Hz left hemisphere source. While the small numbers of participants within the subgroup analyses reduce the statistical power, this study suggests that those with greater magnitudes of hearing loss show greater cortical disruptions with tinnitus and that tinnitus treatment appears to reduce the tonotopic map disruptions but not the source strength (or central gain).     

Some ocular symptoms experienced by users of mobile phones

This survey study was conducted, using a questionnaire, on 229 university students (181 women, 48 men) in Kocaeli, Turkey. Six ocular symptoms experienced during use of mobile phones were studied by means of the chi-square test with Yates correction. The studied symptoms were blurring of vision, redness of the eyes, vision disturbance, secretion of the eyes, inflammation in the eyes, and lachrymation of the eyes. A significant increase in blurring of vision (p < 0.05) was reported by users of mobile phone possession >2 years compared to users of mobile phone possession <2 years. In users of mobile phones, women significantly (p < 0.05) complained more often of inflammation in the eyes than men.     

Mandarin Speech Perception in Combined Electric and Acoustic Stimulation

For deaf individuals with residual low-frequency acoustic hearing, combined use of a cochlear implant (CI) and hearing aid (HA) typically provides better speech understanding than with either device alone. Because of coarse spectral resolution, CIs do not provide fundamental frequency (F0) information that contributes to understanding of tonal languages such as Mandarin Chinese. The HA can provide good representation of F0 and, depending on the range of aided acoustic hearing, first and second formant (F1 and F2) information. In this study, Mandarin tone, vowel, and consonant recognition in quiet and noise was measured in 12 adult Mandarin-speaking bimodal listeners with the CI-only and with the CI+HA. Tone recognition was significantly better with the CI+HA in noise, but not in quiet. Vowel recognition was significantly better with the CI+HA in quiet, but not in noise. There was no significant difference in consonant recognition between the CI-only and the CI+HA in quiet or in noise. There was a wide range in bimodal benefit, with improvements often greater than 20 percentage points in some tests and conditions. The bimodal benefit was compared to CI subjects’ HA-aided pure-tone average (PTA) thresholds between 250 and 2000 Hz; subjects were divided into two groups: “better” PTA (<50 dB HL) or “poorer” PTA (>50 dB HL). The bimodal benefit differed significantly between groups only for consonant recognition. The bimodal benefit for tone recognition in quiet was significantly correlated with CI experience, suggesting that bimodal CI users learn to better combine low-frequency spectro-temporal information from acoustic hearing with temporal envelope information from electric hearing. Given the small number of subjects in this study (n = 12), further research with Chinese bimodal listeners may provide more information regarding the contribution of acoustic and electric hearing to tonal language perception.     

Noise-induced hearing loss and blood pressure.

From a group of industrial workers who had a noise-induced hearing loss of at least 30 dB at 4000 Hz 62 were randomly selected after stratification. Controls matched for age and duration of employment were also selected. Resting blood pressures were measured and audiometry was repeated. The findings are presented by age group and for the two groups as a whole. No relation between systolic or diastolic blood pressure and hearing loss was found, and equal proportions of each group had blood pressures exceeding 140/90 mm Hg. Persons with greater hearing loss (more than 60 dB at 4000 Hz) did not have significantly higher blood pressures than their matched controls.     

Delayed detection of congenital hearing loss in high risk infants.

OBJECTIVE--To examine the methods used to investigate children at high risk of congenital hearing impairment, and to see whether the introduction of evoked response audiometry has reduced the mean age at which hearing loss is identified. DESIGN--Clinicians who notified children to the national congenital rubella surveillance programme were asked retrospectively to complete a questionnaire examining the methods used to identify hearing impairment and the age at testing in two consecutive five year cohorts. The presence or absence of hearing loss was confirmed by obtaining the results of audiometric evaluations and, whenever possible, a recent pure tone audiogram. SETTING--The United Kingdom. PATIENTS--Children notified to the national congenital rubella surveillance programme and born in 1978-87 in whom IgM specific for rubella was detected shortly after birth. MAIN OUTCOME MEASURES--The age at which hearing loss was identified and the degree of loss in decibels at 250, 500, 1000, 2000, and 4000 Hz measured by pure tone audiometry. RESULTS--61 (52%) Of 117 children born in 1978-82 had a hearing impairment of 40 dB or greater in both ears. The mean loss was 93 dB. In the following five years 75 (47%) of 159 children had impaired hearing, their mean loss being 96 dB. The age at which the hearing loss was confirmed decreased from 11.6 to 9.8 months as a result of earlier auditory evoked response testing. Nevertheless, only eight (13%) of the children with hearing impairment born in 1978-82 and 16 (21%) of those born in 1983-7 had these tests performed in the first six months of life. CONCLUSIONS--Unacceptable delays in identifying hearing loss occurred in this high risk group because of failure to arrange auditory evoked response testing in early infancy. Evoked response audiometry is sensitive and specific and should be undertaken within the first few months of life for all infants known to be at risk of sensorineural hearing loss.     

Relationship between Audiometric slope and tinnitus pitch in tinnitus patients: insights into the mechanisms of tinnitus generation

Background

Different mechanisms have been proposed to be involved in tinnitus generation, among them reduced lateral inhibition and homeostatic plasticity. On a perceptual level these different mechanisms should be reflected by the relationship between the individual audiometric slope and the perceived tinnitus pitch. Whereas some studies found the tinnitus pitch corresponding to the maximum hearing loss, others stressed the relevance of the edge frequency. This study investigates the relationship between tinnitus pitch and audiometric slope in a large sample.

Methodology

This retrospective observational study analyzed 286 patients. The matched tinnitus pitch was compared to the frequency of maximum hearing loss and the edge of the audiogram (steepest hearing loss) by t-tests and correlation coefficients. These analyses were performed for the whole group and for sub-groups (uni- vs. bilateral (117 vs. 338 ears), pure-tone vs. narrow-band (340 vs. 115 ears), and low and high audiometric slope (114 vs. 113 ears)).

Findings

For the right ear, tinnitus pitch was in the same range and correlated significantly with the frequency of maximum hearing loss, but differed from and did not correlate with the edge frequency. For the left ear, similar results were found but the correlation between tinnitus pitch and maximum hearing loss did not reach significance. Sub-group analyses (bi- and unilateral, tinnitus character, slope steepness) revealed identical results except for the sub-group with high audiometric slope which revealed a higher frequency of maximum hearing loss as compared to the tinnitus pitch.

Conclusion

The study-results confirm a relationship between tinnitus pitch and maximum hearing loss but not to the edge frequency, suggesting that tinnitus is rather a fill-in-phenomenon resulting from homeostatic mechanisms, than the result of deficient lateral inhibition. Sub-group analyses suggest that audiometric steepness and the side of affected ear affect this relationship. Future studies should control for these potential confounding factors.     

Characteristics of the hearing loss in unilateral cleft lip and palate-influence on communication

Etiology of otitis media with effusion (OME) is still unclear and often described as multi-factorial. It is very usual finding in cleft palate population. We tested relationship between the hearing level, audiometric frequencies, aging and ear side in unilateral cleft lip and palate 101 children (UCLP) and subgroups of left (UCLP)(L) and right cleft side (UCLP)(R). Group of left ears is prone to higher frequency and more severe hearing disturbances than groups of right ears, with less chance of normalizing hearing level with aging. Characteristics of hearing loss level and its improvement, in UCLP children depend of cleft type, ear side and age group.     

The association between socioeconomic status and exposure to mobile telecommunication networks in children and adolescents

A potential association between socioeconomic status (SES) and self‐reported use of mobile phones has been investigated in a few studies. If measured exposure to mobile phone networks differs by SES in children, it has not yet been studied. Interview data of 1,481 children and 1,505 adolescents on participants' mobile phone use, socio‐demographic characteristics and potential confounders were taken from the German MobilEe‐study. Sociodemographic data was used to stratify participants into three “status groups” (low, middle, high). Using a personal dosimeter, we obtained an exposure profile over 24 h for each of the participants. Exposure levels during waking hours were expressed as mean percentage of the reference level. Children with a low SES were more likely to own a mobile phone (OR 2.1; 95% CI: 1.1–3.9) and also reported to use their mobile phone longer per day (OR 2.4; 95% CI: 1.1–5.4) than children with a high SES. For adolescents, self‐reported duration of mobile phone use per day was also higher with a low SES (OR: 3.4; 95% CI: 1.4–8.4) compared with a high SES. No association between SES and measured exposure to mobile telecommunication networks was seen for children or adolescents. Mobile phone use may differ between status groups with higher use among disadvantaged groups. However, this does not result in higher overall exposure to mobile telecommunication networks. Whether short duration of own mobile phone use or the small numbers of participants with a low SES are causal, have to be investigated in further studies. Bioelectromagnetics 31:20–27, 2010. © 2009 Wiley‐Liss, Inc.     

Whole-body exposure of radiation emitted from 900 MHz mobile phones does not seem to affect the levels of anti-apoptotic bcl-2 protein

The purpose of the present study was to investigate the anti-apoptotic bcl-2 protein in rat brain and testes after whole-body exposure to radiation emitted from 900 MHz cellular phones. Two groups (sham and experimental) of Sprague-Dawley rats of eight rats each were used in the study. Exposure began approximately 10 min after transferring into the exposure cages, a period of time when rats settled down to a prone position and selected a fixed location inside the cage spontaneously. For the experimental group, the phones were in the speech condition for 20 min per day for 1 month. The same procedure was applied to the sham group rats, but the phones were turned off. Immunohistochemical staining of bcl-2 was performed according to the standardized avidin-biotin complex method. The results of this study showed that 20 min of the radiation emitted from 900 MHz cellular phones did not alter anti-apoptotic bcl-2 protein in the brain and testes of rats. We speculate that bcl-2 may not be involved in the effects of radiation on the brain and testes of rats.     

The effects of long-term exposure of magnetic field via 900-MHz GSM radiation on some biochemical parameters and brain histology in rats

The aim of this study is to determine the effects of magnetic field via cell phones on some blood parameters and neurons in the brain of rats. Animals have been classified into three groups: control, Magnetic Field (MF), and F2 groups. Throughout this study, cell phones were placed on the wall of the cages. Rats were exposed to the effects of cell phones during prenatal and postnatal periods until they were 80 days old. During the study, the exposure procedure of rats was that the phone was in standby mode for a whole day and in talking mode for 30 min per day. The waves of cell phones caused an increased blood glucose level from 96.52 ± 5.64 mg/dl to 132.14 ± 5.93 mg/dl and an increased serum protein level from 131.14 ± 6.19 mg/dl to 319.29 ± 6.73 mg/dl compared to control. Statistically, significant differences wasn't observed in the blood cholesterol concentration between the groups compared to the control. Weekly weight gain decreased in all groups compared to the control. MF exposure decreased pyramidal neuron numbers 51.15% and increased ischemic neuron numbers 73% at cortex region of brain. In addition, vascular dilatations have increased clearly in group F2.Whereas the procedure of MF did not have any effects on hippocampal pyramidal cell numbers, magnetic fields increased the amount of ischemic neurons three-fold compared to the control. In conclusion, MF affected some biochemical parameters, especially the cortex region of the brain.     

Effects of an increased air gap on the in vitro interaction of wireless phones with cardiac pacemakers

Several clinical and laboratory studies have demonstrated electromagnetic interaction between implantable cardiac pacemakers and hand-held wireless phones operated in close proximity. Current FDA and HIMA labeling guidelines indicate that a minimum separation of 6 in (15 cm) should be maintained between a hand-held wireless phone and an implanted pacemaker. This separation requirement does not distinguish between lateral locations on the chest and a perpendicular air gap. Evidence is provided here for a substantially reduced separation threshold when measured across an air gap rather than near the saline conductive media of a simulated torso. Twenty pacemaker-phone combinations involving 6 pacemakers and 9 phones were evaluated in vitro under worst-case conditions with respect to phone output power and pacemaker sensitivity. The phones represented CDMA, TDMA-11 Hz, TDMA-22 Hz, TDMA-50 Hz, and TDMA-217 Hz digital wireless technologies. Small increases in the perpendicular air gap between the phone and the saline surface resulted in a dramatic reduction in interaction. Approximately half of the 208 test runs exhibiting interaction at an air gap of 1 cm no longer resulted in interaction when the gap was increased to 2 cm. At a gap of 7.4 cm, the percentage of runs with interaction decreased to 1.4%. The overall interaction rate, considering a total of 8296 test runs from an earlier study, was less than 0.07% at a total perpendicular distance of 8.6 cm from the saline surface to the phone antenna axis. The perpendicular distance threshold of 8.6 cm was significantly less than the horizontal plane projection threshold of 19 cm previously reported. This difference is a function of the electromagnetic field coupling to the saline bath rather than field strength changes along the axis of the phone antenna. The results have implications for those making recommendations to pacemaker patients who may be unaware of this distinction.