What is not recommended for?

Temporary, delaying factors

Fever, rhinitis, upper respiratory tract rhinitis, severe allergy: may cause problematic equalisation or inability to equalise. Fever increases the risk of oxygen toxicity.

Cytostatic therapy with the following agents: doxorubicin, cisplatin, disulfiram, mafenide acetate: HBOT potentiates toxic side effects of drugs

First trimester of pregnancy: not studied and no known fetal effects

Grounds for permanent exclusion

Spontaneous pneumothorax in the history: gas embolism, risk of ptx

Significant obstructive airway disease, severe asthma, COPD: air trapping and risk of gas embolism

Some post-ear surgery conditions: e.g. plastic surgery of the auditory canal

Congenital spherocytosis: severe haemolysis may occur.

 

Temporary deferral or permanent exclusion at individual choice:

- Inability to equalise pressure

- Panic syndrome/ claustrophobia

- Disease not clarified, investigation phase

- Implanted drug pump, pacemaker, epidural pump, hollow eye prosthesis, other implanted electrical device for which the manufacturer cannot guarantee the pressure resistance of the device

For HBO, as for any other medical intervention, we decide on the therapy and its profile after an individual assessment, information and consultation with the treating doctor.

Side effects and their prevention:

Although HBOT is a markedly low-risk treatment procedure and hyperbaric chambers are places with multiple technical security, some things need attention. Side effects are generally mild and rare, and most are preventable with preparation, consultation and education.

Pressure equalisation difficulty: despite all careful preparation, the mucous membrane at the entrance of the ear canal may be strained (2%). It may occur during treatment (on going to pressure) but also after treatment. Symptoms: ear blockage, hearing loss, little change in the patient's well-being, no ear pain, only a slight, dull feeling of pressure and fullness in the ear. Temperature is normal, possibly with a slight rise. Eustachian tube rhinorrhoea associated with HBOT - the mechanism described above - is a mild, non-infectious local reaction with an average course, usually resolving within a few days. Its treatment is aimed at restoring the patency of the auricle. In this case, antihistamine, nasal drops, mild analgesics with a few days of gentle living and avoidance of temperature fluctuations are recommended. In this case, we usually recommend a temporary suspension of HBOT until recovery, and in other cases (stubborn or recurrent) a permanent suspension. In some cases, the disease of the Eustachian tube is prolonged and becomes over-infected. This is not an inevitable consequence of the local reaction to HBOT. The background of the prolonged disease may be nasal polyps, swollen nasal mucosa, hypertrophic rhinitis, nasal septal scarring, enlargement of the lower or middle turbinates, inflammation of the nasal tonsils, enlargement of the pharyngeal tonsils, other nasopharyngeal inflammation, chronic inflammation of the sinuses of the nose, nasal foreign body, nasopharyngeal tumour or reflux disease associated with gastric acidosis and/or gastric mucosal dysfunction. Diagnosis and remediation of this is the speciality of otolaryngology (gastroenterology).

Failure to equalisation: if the pressure in the eardrum fails to equalise through the ear trumpet and this is not reported to the staff in time, the eardrum will become more and more retracted, in fact depressed, as the pressure increases. If the equalisation still fails, the eardrum may be damaged (haemorrhage, rupture) due to the tension. This is called barotrauma. When the eardrum ruptures, there is pain and hearing loss, sometimes accompanied by a small amount of bleeding. A healthy eardrum will heal spontaneously after the injury, and should not be exposed to water, strenuous physical activity or blowing the nose. Despite the favourable prognosis, it is recommended to consult an otolaryngologist and have the condition checked.

Oxygen spasm: HBO therapy delivers high doses of oxygen to the body. This has an 'activating', metabolism-boosting effect, which in certain specific cases (e.g. epilepsy in the history, high fever, CO poisoning, severe dehydration, drug or alcohol abuse in the half day before therapy) may result in increased seizure activity during the time spent on hyperbaric therapy. (0.01%) Signs of "oxygen spasm": sudden dizziness, changes in vision, numbness of the face and hands, muscle twitching. Report it to the chamber attendant, who will immediately remove the oxygen mask, and the symptoms will disappear. If necessary, the condition can be prevented by more frequent oxygen breathing breaks.

Lung: During pressure reduction, lung parts that are closed during chronic lung diseases (e.g. COPD, emphysema, other airway obstructive diseases) may overstretch. In such cases, air can enter the circulation, this is called gas embolism. With this history, we weigh the risk - therapeutic benefit, choosing a slow decompression method if appropriate. If a coughing fit, etc. occurs during the pressure change, the attendant "stops the chamber", suspends compression/decompression and only after this is completed, can the therapeutic immersion resume. The same happens in the case of voluntary breath-holding: therefore, please do not hold your breath during the variable pressure phase either! If you experience any chest discomfort or shortness of breath: please report it to the attendant.

Sinuses: during the course of pressure reduction, gas beneath any solid-walled cavity filled with air (chronically inflamed sinuses, poorly fitted dental fillings, dental crowns) can become trapped during expansion, possibly causing toothache, loosening of bad fillings, crowns. Another good solution is to reduce the pressure more slowly. This should be followed by a consultation with a dentist or an ear specialist.

Vision: temporary blurred vision may occur, lasting a few hours. It is caused by oxygen saturation of the lens of the eye. Patients at risk of cataract (over 50 years, diabetes or steroid treatment or radiotherapy of surrounding tissues) are recommended to have an ophthalmological check-up before HBOT and to record the condition.

Claustrophobia, panic disorder: (2%) the risk-benefit of therapy needs to be carefully weighed, but participation in treatment can only be decided in practice. It is usually helpful if the patient realises that he or she can "get out of the box" even during treatment. The oxygen mask attached to the face can cause subjective discomfort, this is solved by not using a head strap attachment, the patient holds the mask and the head strap is only used when the patient asks for it.

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