Frequently Asked Questions

What is Hyperbaric Oxygen Therapy (HBOT)?

HBOT is defined by the Food and Drug Administration (FDA) as “breathing 100% (pure) oxygen while in a special space called a hyperbaric chamber. The air pressure inside is raised to a level that is higher than normal air pressure“.

How does Hyperbaric Oxygen Therapy (HBOT) work?

HBOT works by saturating the body with oxygen under increased pressure, which helps deliver more oxygen to tissues, promotes healing, and can have various therapeutic effects. It is used to treat a wide range of medical conditions, particularly those where improved oxygen supply can aid in recovery or alleviate symptoms. The treatment is typically administered in a controlled and supervised clinical setting to ensure safety and effectiveness.

What conditions or illnesses can Hyperbaric Oxygen Therapy (HBOT) be used to treat?

HBOT is insurance approved to treat conditions such as decompression sickness, non-healing wounds, carbon monoxide poisoning, radiation injury, and some infections, among others. However, there are many investigational uses for hyperbaric oxygen therapy that are not covered at the moment but are showing plenty of promise.

Is Hyperbaric Oxygen Therapy (HBOT) considered a safe medical treatment?

When administered by trained professionals, HBOT is safe. However, it may have risks and contraindications, so it should be done under medical supervision. HBOT should be done with a hospital grade hyperbaric chamber because they are regulated by the FDA for proper safety precautions.

What are hard shell and soft shell chambers? And what are the differences?

In the world of hyperbaric oxygen therapy there are two types of chambers, hard shell and soft shell. Hard shell chambers are typically considered “hospital grade”. They are easily identifiable by the hard ridged exterior made of solid metal and thick acrylic. These chambers typically go to the higher pressures that are used in almost all hyperbaric oxygen therapy studies. They also typically allow the patient to breathe 100% oxygen, as required to recreate hyperbaric oxygen therapy studies. Hard shell chambers can be FDA and PVHO certified, but just being hard shell does not make them FDA and PVHO certified.

Soft shell or mild hyperbaric chambers are commonly inflatable chambers that can be used in a home environment. However, they do not go to adequate pressures to replicate studies for most uses for hyperbaric oxygen therapy. They also typically do not reach the 100% oxygen required either. The Food and Drug Administration (FDA), American Medical Association (AMA) and the Underwater Hyperbaric Medical Society (UHMS) have put out individual statements warning of the safety concerns posed by these chambers.

What is the history of Hyperbaric Oxygen Therapy (HBOT)?

The history of hyperbaric oxygen therapy (HBOT) is fascinating and spans several centuries. Here's a brief overview of its historical development:

16th Century: The concept of using increased pressure for therapeutic purposes dates back to the 16th century when Swiss physician and alchemist Paracelsus noted the healing properties of compressed air in his writings.

• 17th Century: The first documented use of a diving bell, which exposed individuals to increased pressure underwater, is attributed to Englishman Edmund Halley in the early 18th century. Although not a medical application, it contributed to the understanding of pressure effects on the body.
• 19th Century: French physiologist Paul Bert made significant contributions to the understanding of hyperbaric physiology in the 19th century. He conducted experiments that laid the groundwork for the development of hyperbaric medicine.
• Early 20th Century: Hyperbaric chambers began to be used for the treatment of decompression sickness, also known as "the bends," in the early 20th century. This condition affected divers and workers in pressurized environments.
• Mid-20th Century: The development of hyperbaric medicine as a recognized field accelerated during and after World War II. Hyperbaric chambers were used to treat submariners and pilots who experienced decompression sickness. This era saw significant advances in the understanding and application of hyperbaric oxygen therapy.
• 1960s: The Undersea Medical Society (now known as the Undersea and Hyperbaric Medical Society) was founded in the United States to promote research and establish guidelines for hyperbaric medicine.
• 1970s: HBOT started to gain acceptance in the treatment of various conditions, including non-healing wounds, carbon monoxide poisoning, and gas gangrene.
• 1980s and Beyond: Research into the use of HBOT expanded, leading to its application in a broader range of medical conditions, including diabetic foot ulcers, radiation tissue damage, and chronic bone infections.
• 21st Century: Hyperbaric medicine continues to evolve. Research and clinical trials are ongoing to explore new applications for HBOT and refine treatment protocols.

How is HBOT administered?

It is administered in a specially designed chamber where patients breathe oxygen at increased pressure for a specific duration.

What can I expect during an HBOT session?

During a session, you'll relax in the chamber while breathing oxygen. You may experience pressure changes in your ears similar to flying in an airplane. Most chambers have entertainment systems on the outside of the chamber that allow the patient to watch movies and shows.

How long does a typical HBOT session last?

Sessions typically last 60, 90, or 120 minutes in the chamber. 60 minutes is typically for patients who cannot stay in the chamber for long periods due to anxiety or bladder complications. 90 minutes is the most common length of time in the chamber. 120 minutes is used for extreme cases such as life/limb saving indications and severe tissue necrosis.

Are there any potential risks or side effects associated with HBOT?

Hyperbaric oxygen therapy (HBOT) is generally considered safe when administered by trained healthcare professionals in appropriate settings. At a proper HBOT clinic that uses correct session protocols and the correct safety procedures the likelihood of side effects are limited. However, like any medical treatment, there can be potential side effects and risks. It's essential to be aware of these potential side effects, although they are typically rare. Here are some of the possible side effects of HBOT:

• Ear Barotrauma: The most common side effect of HBOT is ear barotrauma, which can cause ear pain, pressure, or discomfort. This occurs due to the pressure changes in the hyperbaric chamber and can be managed by techniques like equalizing pressure in the ears during treatment.
• Oxygen Toxicity: Breathing 100% oxygen under pressure for extended periods may lead to oxygen toxicity. Symptoms can include nausea, lightheadedness, muscle twitching, or seizures. Healthcare professionals closely monitor the oxygen concentration and treatment duration to minimize this risk.
• Changes in Vision: Temporary changes in vision, such as nearsightedness or farsightedness, can occur during HBOT sessions. These changes are usually reversible once treatment ends.
• Seizures: Individuals with a history of seizures may be at an increased risk of experiencing seizures during HBOT, especially if the treatment involves high pressures or prolonged sessions.
• Fire Hazard: HBOT involves the use of oxygen-rich environments, which can pose a fire hazard if there is a source of ignition within the chamber. Therefore, patients are not allowed to bring flammable materials or electronics into the chamber.
• Claustrophobia or Anxiety: Being in a closed chamber for an extended period may trigger claustrophobia or anxiety in some individuals. The medical staff can provide support and techniques to manage these feelings.

Is HBOT covered by health insurance?

Hyperbaric oxygen therapy is covered for many specific indications (Link to Diagnosis List). Most of them are wound care related. However, there are many investigational uses for HBOT that are not typically covered by insurance. Some plans might consider coverage for an investigational use so it is recommended to talk to your insurance provider.

Are there any contraindications or conditions that would prevent someone from receiving HBOT?

Hyperbaric oxygen therapy may not be suitable for individuals with certain medical conditions or situations due to the potential risks involved. Here is a list of contraindications for HBOT:

• Untreated Pneumothorax: A pneumothorax is a condition where air leaks into the space between the lung and the chest wall, causing lung collapse. HBOT can worsen this condition, so it is contraindicated.
• Severe Chronic Obstructive Pulmonary Disease (COPD): Severe COPD can affect the ability to tolerate increased oxygen levels, and the high pressures in the hyperbaric chamber may exacerbate respiratory distress.
• Active Seizure Disorders: Individuals with uncontrolled seizure disorders may be at increased risk of experiencing seizures during HBOT, especially if the treatment involves higher pressures.
• Certain Medications: Some medications, particularly certain chemotherapeutic drugs, can be adversely affected by the increased oxygen levels during HBOT. Patients on these medications may need to discontinue or adjust their drug regimen before treatment.
• Congenital Spherocytosis: This hereditary blood disorder can cause red blood cells to break down more easily under high oxygen levels, potentially leading to complications during HBOT.
• Cardiac Issues: Patients with certain cardiac conditions, such as aortic aneurysm or unstable angina, may be at risk during HBOT due to the potential stress placed on the cardiovascular system.

Can children or pregnant individuals undergo HBOT treatment?

HBOT can be used in pediatric cases when indicated. Pregnant individuals are typically not recommended to do HBOT. However, they should consult with their healthcare providers to weigh the potential benefits and risks.

What is the cost of HBOT, and is it affordable for most people?

The cost varies widely depending on location and the protocol being used to treat the condition. It can be expensive, and affordability depends on individual circumstances. If the use for HBOT is covered by insurance it can be very affordable and accessible. However, if the indication is not covered by insurance most clinics and hospitals will have a self pay price. Most hospitals' self pay prices range from $2,000 - $6,000 per session. While here at Houston Hyperbaric Oxygen Center we host the lowest self pay cost in the Houston area at $180 - $240 per session on average for most protocols.

Are there any dietary or lifestyle restrictions before or after HBOT sessions?

In some cases, dietary and lifestyle restrictions may be advised, such as avoiding alcohol, caffeine, carbonated drinks, and large meals before sessions.

How can I find a qualified and reputable HBOT treatment center or provider?

Seek recommendations from your healthcare provider, verify the credentials of the facility and staff, and ask about their experience with your specific condition. Before starting treatment at a center ask these questions:

• Are the chambers hard shell chambers? If the chamber is not a hard shell/medical grade you are not getting the same treatment as done in all HBOT studies.
• What protocols do you use? Protocols vary per patient however the facility should be able to explain the reason your protocol might be different from the norm. Certain metabolic effects require specific pressures to achieve specific results.
• Does the patient breathe 100% oxygen in your chamber? It is very important for the patient to be breathing 100% oxygen throughout the treatment. Oxygen concentrators only put out around 80% despite many that claim 95%. The lower percentage of oxygen does not allow the body to get to and maintain the needed raise in partial pressure of oxygen in the arterial system to have the same effects as the studies show.
• Do you do vitals? Vitals are a key component to making sure patients are safe and will not have issues during the treatment. Vitals should be done before and after treatment including looking at the tympanic membrane of the ears and blood sugar. Not looking at the tympanic membrane can result in a barotrauma of the middle ear if not monitored. Not checking blood sugar can lead to an altered mental status or possible seizures of the patient during or after treatment as the body increases metabolism drastically during HBOT. Altered mental status can affect a patient without warning for low blood sugar and must be monitored, not just based on how the patient feels or presents.
• Do you allow electronics in the chambers? Electronics are NOT allowed in hyperbaric chambers for any reason. The National Fire Protection Association (NFPA) says “The following shall be prohibited from inside the chamber: Personal electrically powered devices (e.g., laptops, electronic tablets, cell phones, pagers), and personal entertainment devices. This is a NON-NEGOTIABLE SAFETY PROTOCOL and any facility that does allow electronics inside a chamber is in violation of NFPA 99 Chapter 14.3.1.6.1.2. This rule applies to all chambers, even ones compressing with medical air and providing oxygen through a mask system.
• Do you only allow cotton clothing and bedding in the chambers? The National Fire Protection Association (NFPA) requires 100% cotton bedding and attire in hyperbaric oxygen chambers to reduce the likelihood of static electricity.
• Is there patient supervision at all times? It is very important for the safety of the patient that someone with adequate training is available to help patients at all times. NFPA 99 Chapter 14.3.1.4.6 states During chamber operations with an occupant(s) in a chamber, the operator shall be physically present and shall maintain visual or audible contact with the control panel or the chamber occupant(s).
• Is there a proper communication system in the chamber? Most chambers have the ability to talk to people on the outside of the chamber with a communication system. Not having one makes it difficult for patients to ask questions during the session.
• Is the staff properly trained and certified? All staff involved with operating a hyperbaric chamber shall be trained and hold a certificate for hyperbarics.
• Is the patient grounded in the chamber? Oxygen use can increase any form of combustion. If a spark occurs from static electricity in a hyperbaric chamber it can cause an explosion or a fire. One additional means to prevent this is to us a grounding strap attached to the patient and chamber and is REQUIRED by NFPA 99 Chapter 14.3.1.6.3.2

What ongoing research or developments are there in the field of hyperbaric oxygen therapy?

Research continues to explore new applications for HBOT and refine treatment protocols, so it's important to stay informed about the latest developments in the field. We recommend staying up to date with information posted on Underwater Hyperbaric Medical Society (UHMS) and studies posted to PubMed. You can also find many studies listed on our Studies page here.