Hyperbaric oxygen therapy in ENT
Balasubramanian M.S. D.L.O.
Definition: Hyperbaric oxygen
therapy is defined as administration of 100% oxygen to a patient
placed inside a chamber pressurised to greater than 1 atmosphere at
sea level. Local application of pressurized oxygen to a part of the
body without completely enclosing the patient is not hyper baric
History: In 1662 a British clergyman Henshaw
first built a sealed chamber where compressed oxygen was given as a
cure to various ailments. He also used the term Domicilium
to describe the chamber. Following discovery of oxygen by
Joseph Priestely it has been used to treat various chronic
conditions at high pressures.
It was Dr I. Boerema in 1956
who demonstrated the value of oxygen under high
pressure in management of certain difficult cardiovascular
Indications of Hyperbaric oxygen
1. Arterial air or gas embolism
2. Acute blood loss anaemia
3. Carbon monoxide poisoning, cyanide
poisoning, and smoke inhalation
4. Compromised skin grafts and
5. Crush injury
6. Decompression sickness
7. To facilitate enhanced wound
8. Gas gangrene
9. Necrotising soft tissue
10. Radiation necrosis: Osteoradionecrosis,
soft tissue radionecrosis, caries in radiated bones
11. Refractory osteomyelitis
12. Refractory mycosis
13. Thermal burns
Mechanism of action:
1. Hyperoxygenation - is
achieved by first completely saturating the hemoglobin and then by
increasing the amount of oxygen dissolved in the plasma. This
increases the distance of oxygen diffuses away from the capillaries.
This is three times higher than under normal conditions.
2. Vasoconstriction -
Vasoconstriction caused by hyperbaric oxygen therapy does not reduce
oxygenation, on the contrary it has a benefical effect of reducing
edema in skin grafts and flaps.
3. Anitmicrobial activity - Hyperbaric oxygen
therapy is bactericidial to obligate anaerobes. It
also increases the ability of polymorphs to kill bacteria. It is
also known to inhibit and inactivate the toxins released by
clostridium welchi, thereby preventing gas gangrene.
4. Pressure effects -
Hyperbaric oxygen is used to reduce the size of gas bubble.
Because of this feature it is the treatment of choice in
6. Fibroblastic proliferation
7. Improved functioning of osteoblasts and
8. Increased red cell
Complictions of hyperbaric oxygen
1. Middle ear barotrauma - This can occur if
the patient is unable to equalise the middle ear pressure. This
complication can be best avoided by the use of systemic and topical
nasal decongestants before proceeding with hyperbaric oxygen
therapy. If this condition occurs then myringotomy should be
resorted to without hesitation.
2. Myopia - This is temporary and reverses
back to normal after cessation of treatment.
3. Pneumothorax - can occur if decompression
occur too rapidly or if the patient holds the breath during
4. Oxygen induced seizures - This complication
is very rare. These patients should be given
vitamin E before treatment to protect against
superoxide radicals. Oxygen induced seizures can be stopped by
allowing the patient to breath normal air. Oxygen induced seizures
are not known to cause permanent neurological sequlae.
How to administer hyperbaric
Hyperbaric oxygen is administered by placing
the patient inside oxygen chambers. Two types of chambers are
commonly used for hyperbaric oxygen therapy. 1. Monoplace and 2.
Multiplace chambers. In both these chambers facilities are provided
for monitoring the various vital body parameters like heart rate,
blood pressure and blood oxygen levels etc. Facilities are provided
for intravenous administration of drugs and fluids.
Monoplace chamber: Here 100% pressurised
oxygen is utilized. Patient alone is placed in this
type of chamber. There is no space for attendants. The patient is
placed alone inside this chamber. This chamber is hence not useful
in critically ill patients.
Multiplace chamber: These chambers are
pressurised with air. Patients inside this chamber are administered
100% oxygen via a face mask or hood. These chambers allow one or
more attendants inside them. This feature is advantageous in
treating seriously ill patients.
Fig showing hyperbaric oxygen
Regardless of the type of chamber used the
following factors must be considered:
1. The amount of pressure used.
2. Duration of the treatment.
3. How often the treatment is
To avoid oxygen toxicity the treatment
duration should not exceed 120 minutes. The safe range being 90 -
120 minutes. The pressure used is about 2 atmospheres. When a
patient's condition require multiple hyperbaric oxygen treatments
per day, a minimum duration of 6 hours between them is a must.
Indications of hyperbaric oxygen
1. Radiation induced soft tissue necrosis:
Hyperbaric oxygen therapy promotes neovascularisation. Hypoxia is
corrected and wound heals faster.
2. Osteoradionecrosis: Hyperoxygenation and
neovascularisation helps in treating this difficult condition.
Hyperbaric oxygen treatment is an effective adjuvant to antibiotics
in managing this condition.
3. Prevention of mandibular
4. In treating necrotising soft tissue
5. In management of malignant otitis
6. Can be used in management of fungal
infections of head and neck. This has a proven value as an adjunct
to the regular antifungal agents.
7. Managment of acute blood loss
8. Can be used to salvage compromised skin
grafts and flaps
9. Can be used as an adjunct in the management
of patients with burns
10. Can be used to manage air or gas
Contraindications of hyperbaric oxygen
2. Pulmonary damage
1. Pulmonary bulla
2. Seizure disorder
3. Patients on high dose of
4. Chronic obstructive pulmonary
5. Recent myocardial infarction
6. Patients with claustrophobia
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