The Robert M. Lombard Hyperbaric Oxygenation Medical Center, Inc.

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The appropriate use of hyperbaric oxygen is one of the safest therapeutic procedures available to the modern practitioner.  However, as with any medical therapy,

there are a few risks associated with it.  The most common are highlighted here: 


v     Barotrauma:  Injury to the middle ear from an inability to properly equalize air pressure during pressurization. External air pressure changes can cause discomfort in the ear canal, whether it’s from flying in an airplane, driving over a mountain or undergoing a hyperbaric oxygen treatment.  This is caused by an imbalance of pressure in the middle ear.  Most commonly, simply by swallowing, the pressure differences in the middle ear are naturally rebalanced via the Eustachian tube and the ears equalize.  Several techniques are explained to the participants in order to facilitate the equalization process.  Care is taken by the technician to control or reduce the pressure until the ears equalize.  If applicable, in some cases, a decongestant may be recommended to reduce sinus fluids.  Some patients use EarPlanes®, sold over the counter in many drug stores, which are small specialized ear plugs designed to reduce problems with equilibration.  For persons who are unable to equalize their ears after trying the above remedies, tiny pressure equalization tubes may be surgically implanted in the ear before coming for therapy. 


v     Sinus Pain:  Fluid build-up or a blockage in the sinus cavities may result in “sinus squeeze,” a temporary painful condition which can be alleviated by slow compression or decongestants.


v     Seizures.  Oxygen-induced seizures rarely occur during therapeutic HBO treatments.  Increased neuro-activity in the brain may result in a seizure for susceptible brain-injured patients as brain activity increases during therapy.  On the contrary, many patients report a reduction in seizure activity in seizure-prone patients over the course of treatments.


v     Cataract formation:  Studies have shown that 7 of 15 patients receiving over 150 to 850 daily HBO treatments at pressures between 2.0 and 2.5 ATA developed new cataracts.  Cumulative treatments spread over time had no effect on cataract development.


v     Pneumothorax:  Patients with a history of a collapsed lung may be more susceptible to having a spontaneous pneumothorax in chamber.  This is an extremely rare occurrence.


v     Dental Pain:  An air bubble trapped between the tooth and the filling may result in discomfort during treatment.  Although rare, a small percentage of patients nationwide reported this discomfort.


v     Oxygen Toxicity:  Although rare, it may occur in prolonged oxygen exposure under high pressure.




Common Side Effects


v     Serous Otitis Media:  An acute or chronic collection of fluid in the middle ear, where fluid cannot drain down the Eustachian tube, either because of an upper respiratory infection or an attack of nasal allergy or from long standing Eustachian tube blockage.  This fluid may have thickened so that it cannot be absorbed or drained easily.  Hearing is diminished, similar to having “cotton in the ears.”  Normal hearing returns after a few weeks when the fluid is drained.  Sinus decongestants may help alleviate the blockage.


v     Visual Refractory Changes:  Over multiple treatments, pressure can also temporarily affect the lens of the eye and vision may worsen or improve.  Typically, patients with presbyopia may notice a vision improvement; those with myopia may notice blurriness.  Each of these refractory changes reverts to pre-hyperbaric condition usually within 6 weeks after cessation of therapy. 


v     Alternobaric Vertigo: A sudden brief disorientation may occur when the pressure is reduced at the end of a treatment.


v     Confinement Anxiety:  About 1 in 50 patients experiences anxiety during treatments.  Calming techniques can be employed to reduce the anxiety and if necessary and appropriate, a mild sedative may be taken before treatment.


v     Numbness in fingers:  Tingling in the fourth and fifth fingers of the hands has occurred in a small percentage of patients nationwide.  This disappears a few weeks after cessation of therapy.


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Fortunately, there are only a small number of preexisting conditions that prevent participation in hyperbaric oxygen therapy, some of which are only temporary.


v     Chemotherapeutic drugs:  Hyperbaric oxygen therapy is contraindicated while undergoing chemotherapy when using certain drugs.  A few days after the cancer treatment is completed, however, HBO therapy may be safely started or continued.


v     Certain Medications: A person may undergo HBO therapy after the cessation of the following drugs: Bleomycin, Disulfiram (Antabuse®), Cis-Platinum, Mafenide Acetate (Sulfamylon®).


v     Low Ejection Fraction:  A heart patient with an ejection fraction of 35 or less is contraindicated for therapy.  This is usually from a weak heart muscle, or compromised cardio system.


v     Emphysema:  Decreased surface area in lungs involving damage to the aveoli; added external pressure makes it harder to "catch your breath."


v     Untreated Pneumothorax (collapsed lung).

Special Considerations


Special consideration must be given to each patient for any of the following:


v     Low Blood Sugar:  Once the blood sugar is elevated, HBO therapy may continue.


v     Pregnancy:  Routine treatments are not given during a woman’s pregnancy.


v     Epilepsy:  Anticonvulsant medications taken by the patient must be at therapeutic levels in the bloodstream prior to treatment.


v     Pacemakers:  Each manufacturer’s recommendations must be followed.


v     Upper Respiratory Infection and Chronic Sinusitis:  Increases difficulty in “clearing the ears.”


v     Congenital Spherocytosis:  A disorder of the red blood cell membrane, which makes it susceptible to fragmentation.  Red blood cells must be strong and deformable to withstand the stress of circulating in the blood and passing through narrow capillaries. 


v     High Fever:  HBO therapy may exacerbate symptoms.


v     History of Thoracic Surgery. 


v     History of Otosclerosis Surgery: Requires placement of pressure equalization tube to help manage pressure changes in the middle ear.


v     History of Optic Neuritis: Treatment stopped if visual impairment occurs.


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