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What is Hyperbaric Oxygen Therapy (HBO)??

In hyperbaric oxygen therapy (HBO for short), the patient breathes in medically pure oxygen for a set period of time in a hyperbaric chamber with a mask or, in special cases, through a head tent. The oxygen is passed on to the blood via the lungs. The red blood cells, which transport the oxygen, are almost completely saturated with oxygen even during normal air breathing and can only take up a little more.

Due to the increased pressure, the oxygen in the blood fluid is increasingly physically dissolved – similar to the carbonic acid in an unopened bottle of mineral water. Compared to breathing normal atmospheric air, around 20 times the amount of oxygen can be transported in the blood during HBO therapy. In this way, those body tissues which, because of their location at the end point of the body’s blood flow, are less well supplied with corresponding diseases, can receive more oxygen

Depiction of the oxygen uptake:

  1. Chemically to hemoglobin (under normal ambient pressure)
  2. Physically to the plasma (under overpressure)

Positive effects of oxygen under overpressure:

The diffusion conditions for oxygen from the blood into the tissue to supply the body’s cells can be affected by various factors. The result is a lack of oxygen with a correspondingly restricted energy metabolism.When the oxygen partial pressure is increased during the HBO treatment, the diffusion distance for the oxygen is up to four times longer than with normobaric air respiration. As a result, the oxygen also reaches areas of the body that are further away from the blood vessels and are not supplied with oxygen, which leads to compensation for the oxygen deficit there. Cells that are responsible for building new tissue during the healing of wounds need a minimum amount of oxygen for their function. If this is not available because the blood supply in large or small vessels is reduced, wound healing disorders can occur. These often occur, for example, as so-called “spread legs” in diabetics. Improving oxygenation during HBOT can activate these healing cells and promote wound closure. The formation and breakdown of bone substance is fundamentally dependent on oxygen. HBO treatment has a positive effect on the function of these cells, which is greatly reduced in certain diseases. HBO works against germs in several ways. Certain pathogens (so-called anaerobes) cannot survive in an oxygen-rich environment; they are killed directly during HBO therapy and their toxins are also inactivated. Some of the body’s defense cells – so-called scavenger cells – need large amounts of oxygen to kill germs. If there is a lack of oxygen, their function is impaired and the immune system is reduced; as a result, wounds can become infected. HBOT can improve the performance of these cells and thus
their immune function. In addition, the effect of some antibiotics in fighting infections is increased. When there is an oversupply of oxygen, HBOT causes certain blood vessels to narrow and can therefore make a significant contribution to reducing 
swelling.

Examinations before the first therapy:

Precise information about the patient’s state of health is absolutely necessary; For this purpose, a patient questionnaire must be carefully filled out before the first consultation with the doctor. Before the patient can be treated in the hyperbaric chamber, the suitability of the hyperbaric chamber must be determined. For this purpose, a thorough physical examination, a check of the lung function, the preparation of an ECG and, if necessary, a stress ECG and, depending on the underlying disease, further tests are carried out. In addition, an X-ray of the lungs no older than two years is required. Some diseases make treatment in the hyperbaric chamber very difficult or rule out therapy. These include:

  • known seizure disorders (e.g. epilepsy)
  • uncontrollable anxiety in confined spaces
  • relevant lung diseases
  • serious heart and circulatory problems

Even during pregnancy, HBO therapy should only be carried out in emergencies after prior consultation with the doctor treating you. In any case, the expected benefits of HBO therapy must exceed the risk of side effects of HBO
therapy. This decision is made individually for each patient. Side effects of HBO: As with any treatment, therapy with hyperbaric oxygen can also have side effects, which, however, are very rare with thorough preliminary examinations and the certified suitability for hyperbaric chambers. The administration of pure oxygen under conditions of overpressure must be precisely dosed and monitored. Specially trained staff and the latest surveillance technology (viewing windows, video cameras and intercoms) contribute to optimum security. Patients are informed in detail about possible side effects by the hyperbaric chamber doctor before the start of treatment as part of the detailed informational discussion.

Areas of application for HBO therapy

  1. Whether chronic wounds, bone diseases or late effects of radiation, whether acute hearing disorders such as sudden hearing loss, tinnitus and acoustic trauma and a number of other indications: Hyperbaric oxygen therapy is used successfully for both acute and chronic diseases that benefit from an increased supply of oxygen.   
  2. Long Covid Syndrome:So far, only one thing has helped against Long Covid: Not getting infected with the corona virus in the first place. Israeli researchers have now found a treatment method that could bring significant relief
    to the millions of people suffering from Long Covid: the symptoms of the disease can be alleviated
    with high-pressure pure oxygen
  1. Before the treatment, the patients who took part in a study by Tel Aviv University suffered from persistent exhaustion, concentration problems, difficulty finding words, but also in some cases from psychiatric problems such as depression and anxiety disorders. The researchers subjected those affected tintensive high-pressure oxygen therapy for a few weeks. At the same time, possible changes in the brain were measured using magnetic resonance.

success is even visible

Before the start of treatment, the images showed that the coronavirus had caused lasting damage to the frontal lobe of the brain. In the course of the treatment, not only did the condition of those affected improve, the visible damage in the brain also partially regressed. The improvement was also m m evident in cognitive tests given to the subjects. Previously, high-pressure oxygen therapy had been shown to be effective in the treatment of stroke or brain trauma. The researchers at Tel Aviv University suspected that the method could also be used against Long Covid. They subjected 73 long   Covid patients to therapy with pure oxygen administered via a mask five days a week for two months. Air was administered to the control group.

Regeneration of the cell structure in the brain

At the end of the treatment, the group that had been treated with high-pressure therapy showed a significant improvement in their symptoms. In the control group, on the other hand, the symptoms remained largely unchanged, and magnetic resonance also showed no change. The greatest advances were made in the therapy for those affected’s ability to concentrate, but also for their ability to plan and carry out tasks. New information could be processed faster. The therapy also alleviated the psychiatric symptoms and improved the quality of sleep. The therapy helps the brain to regenerate its cell structure, explains Shani Itskovich-Zilberman from the research team. Study leader Shai Efra sees the research results as a breakthrough. “For millions of people suffering from long-term Covid symptoms, the study promises new hope for recovery.” And not only that: the research results could also provide information about other clinical pictures,believes Efrati. The study has made it clear that viral diseases can trigger chronic neurological and
psychiatric disorders. Further research in this area could bring new therapeutic approaches for previously untreatable complaints. (Maria Sterkl, July 26, 2022)

1. 2. Wound healing disorders / problem wounds / soft tissues

  • Diabetic foot syndrome, diabetic problem wounds
  • Chronic non-healing wounds
  • Compromised skin and/or musculoskeletal graft
  • Extensive and/or deep soft tissue damage (crush injury, compartment syndrome)
    Chronic connective tissue and rheumatological diseases e.g. polymyalgia rheumatica, rheumatoid arthritis
    Hyperbaric oxygen treatment for diabetic foot aims to heal poorly healing, chronic wounds.The enrichment of oxygen in the affected tissue through HBO therapy not only prevents further deterioration of the wound. Healing processes are stimulated. After about 15 HBO treatments, a deep-reaching regeneration process begins due to the formation of new blood vessels, even in the case of a previously therapy-resistant wound. In addition, oxygen under overpressure kills bacteria. Amputations can be avoided or limited by hyperbaric oxygen therapy. Painless oxygen mapping is performed prior to HBO to assess treatment prospects. It is tested whether the tissue texture allows oxygen permeability in the affected areas.

Bone and bone marrow disorders

  • Chronic periosteum and bone inflammation (osteitis, osteomyelitis) 
  • Circulatory disorders of the bone, so-called aseptic bone necrosis (e.g. femoral head necrosis,
    Ahlback’s disease)
  • Impaired bone fracture healing (e.g. calcaneus/talus fractures)
  • Bone marrow edema syndrome (BMOES)

HBO therapy in orthopedics for aseptic bone necrosis

The treatment goal of HBOT for femoral head necrosis, Ahlbäck’s disease of the knee joint or bone marrow edema syndrome (KMOES) is to reverse the circulatory disorder in the bone tissue and to regenerate the damaged bone cells. When treated with hyperbaric oxygen, patients with aseptic bone necrosis, or BMEES, often experience a reduction in joint pain and are able to avoid pain medication. The less the bone necrosis has progressed, the better the chances of avoiding the impending “bone infarction” and thus the joint replacement. By preserving one’s own knee and hip joint with the help of hyperbaric oxygen therapy, risky surgical risks that are repeated over the course of life can be avoided.

MRI shows chances and treatment successes of HBO

MRI scans enable an exact assessment of the chances of recovery associated with HBO before the start of therapy with hyperbaric oxygen. In addition, the therapy result achieved with hyperbaric oxygen therapy in the case of bone necrosis, bone marrow edema and Ahlback’s disease can be precisely verified and documented by MRI images. In close cooperation with the treating orthopedist or radiologist, the HBO doctors at the Hyperbaric Oxygen Center in Munich develop an oxygen hyperbaric therapy tailored to your symptoms. As a rule, a daily treatment takes place over about 3 weeks or 20 treatments should take place in the therapy pressur chamber.

How does HBO work in femoral head necrosis, Ahlback's disease or bone marrow edema?

During HBO therapy, the oxygen needed to regenerate the damaged bone cells can penetrate fromthe smallest blood vessels up to four times further into the tissue. An existing bone marrow edema is reduced by the vasoconstriction. New blood vessels are formed, cells that form connective tissue are activated, connective tissue fibers are multiplied and networked with one another. The stimulation of the bone-degrading and building-up cells leads to bone regeneration

Prevention and therapy of late effects of radiation

  • Osteoradionecrosis in the mouth, jaw and face
  • Radiation cystitis of the bladder after radiation
  • Radiation proctitis in the rectum after radiation

HBO therapy in oral and maxillofacial surgery (MCG)

Especially in the case of a previously damaged jawbone, e.g. latent inflammation, bone loss in older patients, heavy smokers, etc., the healing of implants is not certain. Even bone augmentation does not always lead to a satisfactory result. Sometimes the dentist therefore has to advise against implants. The only thing left for the patient is the prosthesis or a bridge. For better healing of an implant, the jawbone is optimally prepared with hyperbaric oxygen. Due to the high oxygen concentration in the blood, the jawbone is perfused with much more oxygen-rich blood than usual. This causes bone inflammation to heal. It also leads to the budding of small blood vessels and the formation of new bone trabeculae. The jawbone is strengthened overall. In a jawbone that is strengthened and well supplied with blood in this way, the oral surgeon can easily place several implants successfully. Depending on the individual condition of the jawbone, around 10 treatments with hyperbaric oxygen are required before implantation. In order to consolidate the result even better, a few more sessions after the procedure may be necessary.

HBO therapy in urology and gynecology

With the help of hyperbaric oxygen therapy, late effects of radiation on the bladder and rectum can be treated gently and with very good success rates without further surgical interventions or medication. HBOT can even heal chronic wounds inside the body caused by damage to the particularly radiation-sensitive blood vessels in the skin of the intestines and bladder. It opens up a completely new quality of life for those affected by the long-term effects of cancer treatment: the persistent bleeding, pain or inflammation typical of radiation proctitis or radiation cystitis can be brought to a standstill, transfusions and interventions such as bladder removal or the insertion of an artificial bowel outlet can be prevented with HBOT.

How does hyperbaric oxygen therapy (HBO) work in the late effects of radiation?

The period in which late effects of radiotherapy such as radiation proctitis and radiation cystitis can occur is between 30 days and 30 years after the start of radiation. Hyperbaric oxygen therapy improves the immune function of white blood cells and strengthens those enzyme systems that kill bacteria. The HBOT stimulates the formation of new blood vessels and the formation of connective tissue in the tissue damaged by radiation. Due to the alternation of oxygen deficiency and oxygen  oversupply, new blood vessels grow. For the treatment of radiation proctitis or radiation cystitis, daily HBO treatments of 3 times 30 minutes with medically pure oxygen under pressure over a period of at least 3 weeks are useful.

Scientifically proven: Treatment success of HBO in post-radiogenic soft tissue damage

lready at the consensus conference of the European Society for RadiaƟon Oncology (ESTRO) and the European Society for Hyperbaric Medicine (ECHM) in Lisbon 2001, it was found that hyperbaric oxygen therapy can be used successfully for post-radiogenic soft tissue damage that cannot  otherwise be treated causally. In the meantime, other high-quality studies up to evidence class 1b
have been added, which further justify and secure the use of this therapy in radiation cystitis and radiation proctitis. It should also be pointed out that numerous studies with lower levels of evidence consistently show consistent results. Hyperbaric oxygen therapy for hemorrhagic radiation cystitis after prostate carcinoma. dr S Degener , H Strelow , A Pohle , DA Lazica, J. Windolf, J. Zumbé, S. Roth, A.S. brand. In: The Urologist 2012-51: 1735-1740. Hyperbaric oxygen therapy (HBOT) represents a “promising, although still rarely used, alternative for recurrent or interventionally unmanageable hematuria”. The results show that HBO is a form of therapy that can treat these serious complications of radiotherapy “with a success rate of 90% and a very low rate of side effects”. To the summary of the study on springermedizin.de. An American study from 2011 reports a positive course of therapy in 89 percent of patients treated with HBO with radiation cystitis: Prospective assessment of outcomes in 411 patients treated with hyperbaric oxygen for chronic radiation tissue injury. Neil B Hampson, MD1; James R Holm, MD1; Claude E. Wreford-Brown, CHRN1; and John Feldmeier, DO. In: Cancer, 12/2011

Acute inner ear disorders / inner ear perception disorders

    • Acute hearing loss
    • Tinnitus (ringing in the ears)
    • Acoustic trauma, noise trauma (acute noise damage)
    • Meniere’s disease (ringing in the ears, hearing loss and dizziness)

HBO therapy in ear, nose and throat medicine (ENT)

The aim of HBO therapy for acute hearing disorders is to eliminate the oxygen deficiency in the inner ear and thus regenerate the damaged sensory cells. Since the causes of sudden hearing loss or tinnitus are too different or often unclear, there is currently no therapy that can guarantee an absolutely reliable treatment success for these acute inner ear diseases. However, to ensure that these hearing disorders – such as sudden deafness in the event of sudden hearing loss and acoustic accidents or permanent ringing in the ears – do not become chronic, all available treatment options should be exhausted as quickly as possible. It has been proven that the best treatment successes are achieved within 3 months after the onset of the hearing impairment or ringing in the ears. Conventional medical therapies for sudden hearing loss, acoustic trauma and tinnitus include drugs that stimulate circulation, such as tablets and infusions, anti-inflammatory cortisone and hyperbaric oxygen therapy (HBO).

HBO as a combination therapy and treatment alternative for acute hearing disorders?

In the case of sudden hearing loss, acoustic trauma and tinnitus, rapid ENT treatment is not the only thing that makes sense if the symptoms have not gone away on their own after one to three days. A step-by-step combination therapy with medication, infusions and hyperbaric oxygen therapy has also proven itself, which we carry out at the Hyperbaric Oxygen Center in Munich in cooperation with the treating ENT specialists. The use of hyperbaric oxygen is also a treatment alternative if standard therapies initially carried out for acute hearing disorders were unsuccessful or intolerable.

How does HBO work in acute hearing loss, tinnitus, bang and acoustic trauma?

Breathing in medically pure oxygen in the therapy pressure chamber increases the oxygen content in the nutrient fluid of the sensory cells in the inner ear. The oxygen needed to regenerate damaged sensory cells can penetrate from the smallest blood vessels up to four times further into the tissue of the inner ear. In the case of acoustic trauma, sudden hearing loss and tinnitus, between 10 and 20 HBO sessions of 2 hours and 15 minutes each are required, which should follow one another in a compressed period of time. Success is checked by ENT examinations

HBO for acute hearing loss and acoustic trauma: A therapy recognized worldwide?

For the effectiveness of HBOT in sudden hearing loss, there is currently the best scientific data of all treatment options. There are randomized studies of evidence class 1b that have demonstrated the positive effect of HBOT. It is recommended in the evidence-based US ENT guidelines as an adjuvant therapy option for sudden hearing loss. The “European Manual of Medicine Otorhinolaryngology, Head and Neck Surgery” published by the UEMS (Union Européenne de Médecins Spécialistes) in 2010 also documents the effectiveness of hyperbaric oxygen therapy for hearing disorders. Hyperbaric oxygen therapy is also an internationally recognized treatment method for acoustic trauma. Numerous army hospitals have therapy pressure chambers to effectively treat acoustic and explosion trauma.

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Diseases of the eye

  • Anterior ischemic optic neuropathy (central artery occlusion of the eye)

Other indications

Breathing pure oxygen at normal ambient pressure is already an established treatment for migraines. Therapy with HBO as part of a multimodal therapy concept can help, especially in therapy-resistant cases with prolonged seizures (lasting several days) and with increasing drug intolerance. The increased supply of hyperbaric oxygen during HBO therapy in the pressure chamber reduces the swelling of the nerve cells. Oxygen leads to vascular  constriction and thus flushing out of the edema with subsequent improvement in blood circulation. The cell metabolism normalizes. The acute attack is often terminated after just a few breaths of O2 under hyperbaric conditions, and the patients are pain-free almost immediately. Hyperbaric oxygen therapy is a treatment alternative, especially for drug intolerance and migraine prophylaxis.

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Lyme disease

Bei chronischer Borreliose bzw. Lyme-Arthritis kann die hyperbare Sauerstofftherapie experimentell eingesetzt werden, um die Beschwerden wie unspezifische Schmerzen (Fibromyalgie) , Gelenkschwellungen, Gehschwächen und Arthrose zu bessern Allerdings ist der Wirkungsmechanismus noch nicht ausreichend aufgeklärt, weshalb die Therapie nur in besonderen Ausnahmefällen angewendet wird. Man geht von der Annahme aus, dass der hohe Sauerstoffpartialdruck im Körper den Krankheitserreger vernichtet oder zumindest dezimiert und zwar auch dort, wohin Antibiotika nicht vordringen können. Wir bieten deshalb Patienten bei chronischer Borreliose / chronischer Lyme-Krankheit die HBO-Therapie als Behandlungsversuch an, insbesondere als weitere Chance nach mehreren Serien erfolgloser Antibiotika-Therapien.pressure in the body destroys the pathogen or at least decimates it, even where antibiotics cannot penetrate. We therefore offer patients with chronic Lyme disease chronic Lyme disease HBO therapy as a treatment attempt, especially as a further chance after several series of unsuccessful
antibiotic therapies.  

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Emergency indication

  • Diving accident / compressed air accident (decompression illness)
  • Carbon monoxide poisoning, smoke inhalation
  • air and gas embolisms
  • Gas gangrene and other necrotizing soft  tissue infection
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