Hyperbaric Oxygen Therapy Questions

How does hyperbaric oxygen therapy (HBOT) work?

Breathing 100% oxygen at an increased pressure greatly enhances the supply of life giving oxygen to the tissues. To understand how HBOT works, one must first realize that under normal conditions (one atmosphere absolute or ATA), we are subjected to approximately 14.7 pounds per square inch of pressure. The air we breathe is composed of 21% oxygen and 79% nitrogen. During HBOT, those conditions are altered. The pressures can be increased while 100% oxygen is breathed by the patient by mask or oxygen hood.

Is hyperbaric oxygen treatment painful?

Hyperbaric oxygen treatments are usually painless, but patients may experience a full sensation in their ears, similar to driving up or down a mountain road, changing altitudes in an airplane, or changing depths in underwater diving. The feeling of fullness occurs as the eardrums respond to the changes in atmospheric pressure.

At ground level, the eardrum is normally flat. During compression, the eardrum tends to bow inward and unless positive action is taken, fullness or pain may occur. To avoid this, patients are taught to force air into their middle ear during chamber descent (approximately 10 minutes) when the chamber is being pressurized. Specific maneuvers are: swallowing, moving the lower jaw or blowing air from your lungs out of your nose with you mouth closed and nose pinched. What is actually happening is that air is being forced behind the eardrum, via the eustachian tubes, which connects the middle ear with the throat for passage of air. This greatly reduces the minor risk of ear pain. These procedures are taught to patients by the staff and are practiced thoroughly prior to the patient's first treatment. Pressurization of the chamber can be stopped at any time if the patient feels any type of discomfort. The patient and attending technologist communicate with the hyperbaric physician and chamber operator at all times.

What will the patient feel during the treatment?

Once inside the HBOT chamber, patients will hear air beginning to circulate. Patients are able to see and talk with the chamber staff member, who will tell them when the gradual increase in pressure is begun. This is called compression.

When the prescribed pressure (usually 2.0-2.4 ATA) is reached, the technician inside will place a hood over the patient's head to receive 100% oxygen (the treatment gas) while in the chamber. The hood is clear plastic allowing unobstructed vision. The reoccurring fullness in the ears will stop and patients may rest or sleep during the remainder of the treatment. Patients may choose to read or watch a movie during the treatment which will last approximately 2 hours.

Near the end of your HBOT treatment, the staff will gradually decrease the chamber pressure. This is the decompression phase, which usually lasts for about 10 minutes. During decompression, patients will experience an automatic "popping" sensation in their ears as a result of the decreasing pressure. This may be similar to what is felt in an airplane.

Are there any after effects of HBOT?

Generally, patients will experience no after effects from HBOT. However, some patients report a popping or cracking in their ears between treatments. This sensation should be relieved in the same manner used to clear the ears while in the chamber.

Additionally, some patients report slight fatigue following the first few treatments but should be able to continue with their normal daily activities.

A full explanation of the risks versus benefits will be given to each patient prior to onset of therapy.

What must a patient do to prepare for treatment?

  • Medications: some medications are not compatible with hyperbaric oxygen therapy. Provide the doctor and staff with a complete drug history. Each drug a patient is taking will be considered individually in relation to HBOT and if changes in either medication or schedule are necessary, the patient's physician will be advised.
  • Cold and flu symptoms: it is important to notify the hyperbaric staff of a cold or the flu - including fever, cough, sore throat, runny nose, fever blisters, cold sores, nausea, vomiting, diarrhea or general body aches. It may be difficult for a patient to clear their ears when these symptoms are present. The HBO treatments may be postponed until the patient's symptoms have subsided and their doctor has cleared the patient to resume treatments.
  • Smoking: nicotine is another substance that is incompatible with hyperbaric oxygen therapy. Once HBOT has been prescribed, the patient will be encouraged to stop smoking until the therapy is complete. This "no smoking" rule applies to all forms of tobacco use.
  • Cosmetics: any make-up, hair spray, perfume or shaving lotion containing a petroleum or alcohol base is not allowed during the treatment session.
  • Clothing: it is mandatory patients wear non-static producing clothing during treatments. We recommend patients wear 50% to 100% clean cotton clothing. If the patient requires, we will provide a set of scrubs to wear during treatment. No articles containing nylon, polyester or wools are to be worn in the chamber. Watches and prosthetic devices may also be removed before treatment. Personal cleanliness is also very important to the effectiveness of the treatment and comfort of fellow patients.

How many treatments are needed?

The hyperbaric physician will recommend an individual treatment program. The amount of pressure used and the duration and frequency of the HBO treatments depend upon the specific disorder and its severity. Patients will receive an evaluation by the hyperbaric physician at least every thirty days. The results of this evaluation will determine the need for further treatments. While the hyperbaric will continue to work closely with your referring physician, only the hyperbaric physician has the training and experience to determine when HBOT should be stopped.

What happens during the first visit?

Your primary care physician will refer you to be evaluated by our specially trained hyperbaric physician to determine your candidacy for treatment. If you are considered a qualified candidate for treatment, you will return for subsequent visits to HBOT. You will not have a HBOT treatment during your first visit.

Do I need a referral?

Yes. In order to determine your degree of injury or disease, our physician needs the full medical history of your condition along with a report of your progress and recent medical intervention of your condition from your physician in order to determine your candidacy. This is usually a requirement of your insurance company.

Who is considered a candidate for HBOT?

Because HBOT is used for a specific range of illnesses or diseases, the doctor will evaluate your medical history to determine if you qualify for treatment.

Certain non-healing diabetic ulcers, recurring bone infections, non-healing skin grafts and injuries secondary to radiation therapy are some of the indications for qualifying for HBOT treatment. Only a specially trained, certified physician can specifically determine if a patient qualifies for treatment.