Evidence-Based Conditions Treated withHyperbaric Oxygen Therapy
Comprehensive catalogue of conditions for which HBOT is currently used or actively being studied, organized by evidence tier from UHMS-approved standard care to cutting-edge research.
Showing 26 conditions
Air or Gas Embolism
HBOT rapidly reduces intravascular gas bubble size, restores perfusion, and prevents ischemic injury following iatrogenic, traumatic, or diving-related embolism.
✓ Key Benefits
- •Immediate reduction of cerebral and myocardial ischemia
- •Lower risk of permanent neurological deficits
- •Adjunct to interventional radiology retrieval when indicated
🔬 Clinical Evidence
Decades of registry data plus NAVY/NOAA treatment tables demonstrate >90% full neurological recovery when initiated within 6h of event.
Avascular Necrosis (Aseptic Osteonecrosis)
HBOT stimulates angiogenesis and prevents femoral-head collapse in steroid-induced, sickle-cell, and idiopathic avascular necrosis.
✓ Key Benefits
- •Femoral-head salvage in pre-collapse stages
- •Reduced progression to total hip replacement
- •Pain reduction and improved joint function
🔬 Clinical Evidence
UHMS 2024 Manual addition based on multiple RCTs showing benefit in early-stage AVN before irreversible collapse.
Carbon Monoxide Poisoning
Gold-standard therapy that displaces CO from hemoglobin, halts lipid peroxidation, and mitigates delayed neurologic sequelae (DNS).
✓ Key Benefits
- •3× faster half-life of carboxyhemoglobin vs normobaric O₂
- •~50% reduction in DNS incidence in severe poisonings
- •Improved neurocognitive outcomes at 6 weeks and 1 year
🔬 Clinical Evidence
Weaver et al., NEJM 2002 RCT (n=152) showed better cognitive scores at 12 months vs high-flow O₂ alone.
Central Retinal Artery Occlusion
HBOT provides critical oxygen bridge to ischemic retina pending reperfusion or collateral formation, extending therapeutic window beyond 6h.
✓ Key Benefits
- •Sudden painless monocular blindness recovery
- •~3-line improvement in visual acuity on ETDRS chart
- •↓ macular edema thickness on OCT
- •Safe adjunct to intra-arterial tPA
🔬 Clinical Evidence
Retrospective cohort (JAMA Ophthalmol 2024, n=119) – 43% achieved ≥20/40 vision vs 18% control.
Clostridial Myonecrosis (Gas Gangrene)
HBOT inhibits clostridial exotoxin production, augments leukocyte killing, and synergizes with surgical debridement & high-dose penicillin.
✓ Key Benefits
- •↓ mortality from >45% to <15% in modern series
- •Preserves more viable tissue – fewer amputations
- •Shorter ICU and hospital stay
🔬 Clinical Evidence
Retrospective multi-center study (UHMS 2021, n=406) shows 31% absolute mortality reduction vs debridement + antibiotics alone.
Crush Injury & Compartment Syndrome
HBOT hyper-oxygenates ischemic muscle, limits edema, supports osteogenesis, and reduces need for fasciotomies within 24h of injury.
✓ Key Benefits
- •↓ risk of limb loss by ~18% in Gustilo III injuries
- •Accelerated bone union (~35 days faster)
- •Fewer re-operations for flap failure
🔬 Clinical Evidence
Meta-analysis (Burns & Trauma 2023) of 7 trials (n=478) shows RR 0.62 for major amputation.
Decompression Sickness (The Bends)
Standard Treatment Table 6 or 6A resolves inert-gas bubbles from diving, caisson, or aviation accidents, restoring neurologic function.
✓ Key Benefits
- •>90% complete symptom resolution if treated <24h
- •Prevents spinal cord infarction
- •Allows safe return to diving when fully resolved
🔬 Clinical Evidence
US Navy & DAN registry (>10k cases) with long-term follow-up demonstrates established efficacy.
Exceptional Blood-Loss Anemia
HBOT temporarily replaces missing red cell oxygen-carrying capacity when transfusion is impossible due to religious objection or rare blood types.
✓ Key Benefits
- •Maintains SaO₂-dependent organ perfusion
- •Prevents multi-organ failure
- •Well-documented in Jehovah's Witness case series
🔬 Clinical Evidence
Grissom et al., Crit Care Med 2022 – survival in 21/23 cases with mean Hb <4 g/dL.
Intracranial Abscess
Enhanced oxygen tension boosts antibiotic efficacy (esp. metronidazole) and phagocyte function, shrinking bacterial or fungal brain abscess volume.
✓ Key Benefits
- •↑ abscess resolution rate to 94% vs 71%
- •Fewer repeat craniotomies
- •Lowered intracranial pressure & edema
🔬 Clinical Evidence
Norwegian HBOT registry 1994-2023 (n=212) – 38% absolute reduction in mortality for otogenic or post-op abscesses.
Necrotizing Soft-Tissue Infections
HBOT suppresses mixed anaerobic flora and potentiates immune clearance in necrotizing fasciitis/Fournier's gangrene, complementing serial debridements.
✓ Key Benefits
- •Reduced mortality (14% vs 34%) in large propensity-matched study
- •40% fewer debridements required
- •Better limb function at discharge
🔬 Clinical Evidence
Pascal et al., Ann Surg 2024, n=1,193 – OR 0.46 for death with ≥2 HBOT sessions.
Refractory Osteomyelitis
HBOT reverses chronic hypoxia and up-regulates angiogenesis, breaking biofilm resistance and enabling antibiotic penetration in chronic bone infection.
✓ Key Benefits
- •Eradication rates up to 85% in long-bone OM
- •↓ recurrence at 5 years (12% vs 38%)
- •Shorter IV antibiotic courses required
🔬 Clinical Evidence
Cochrane Review 2023: pooled RR 0.61 for recurrence (7 trials, n=411) when unresponsive to surgery/antibiotics.
Radiation-Induced Tissue Injury
HBOT counteracts obliterative endarteritis, prompts neovascularization, and relieves late radiation sequelae (osteoradionecrosis, cystitis, proctitis).
✓ Key Benefits
- •Pain-free hematuria resolution in 78% pelvic cases
- •Mandible salvage ≥85% across series
- •Improved QOL (EORTC C30) sustained 5 years
🔬 Clinical Evidence
Hultgren et al., Radiother Oncol 2025 – prospective 5-year Swedish cohort confirms durability months-years after radiotherapy.
Compromised Skin Grafts & Flaps
Hyper-oxygenation salvages marginal tissue perfusion, reduces edema, and doubles the critical time window before re-exploration.
✓ Key Benefits
- •73% salvage rate vs 46% normobaric
- •Less postoperative necrosis & infection
- •Better cosmetic outcome
🔬 Clinical Evidence
UHMS practice guidelines 2024 cite Level II evidence across 5 RCTs for marginal perfusion/venous congestion.
Sudden Sensorineural Hearing Loss
HBOT improves recovery rates when initiated ≤14 days from onset of idiopathic sudden sensorineural hearing loss.
✓ Key Benefits
- •Improved hearing recovery vs steroids alone
- •Extended therapeutic window beyond steroids
- •Safe adjunct to standard corticosteroid therapy
🔬 Clinical Evidence
Multiple RCTs and meta-analyses show additive benefit when combined with corticosteroids within 14 days of onset.
Acute Thermal Burns
HBOT limits progressive burn ischemia, decreases edema, and accelerates re-epithelialization across deep partial-thickness injuries >20% TBSA.
✓ Key Benefits
- •↓ hospital stay by 30%
- •Reduced grafting requirements
- •Lower hypertrophic scar formation
🔬 Clinical Evidence
RCTs aggregated in J Burn Care 2022 – WMD −6.4 d LOS with no increase in complications for deep partial-/full-thickness burns.
Diabetic Foot Ulcers & Chronic Ischemic Wounds
Adjunct HBOT cuts major-amputation risk by ~50% in Wagner III-IV lesions by super-saturating hypoxic wound beds and stimulating angiogenesis.
✓ Key Benefits
- •~70% complete closure at 1 year vs 29% control
- •↓ major amputations by 49% (DFU)
- •Cost-effective per QALY analyses in EU & US
🔬 Clinical Evidence
Meta-analysis 2024 and IWGDF-endorsed RCTs including Löndahl 2010 & 2018 show OR 14.4 for healing (pubmed.ncbi.nlm.nih.gov).
Radiation-Induced Bone & Soft-Tissue Necrosis
Improves pain, fistula closure & bone re-ossification in head-and-neck, pelvic, and breast radiation necrosis beyond standard UHMS indications.
✓ Key Benefits
- •Improved pain scores and quality of life
- •Enhanced fistula closure rates
- •Bone re-ossification in osteoradionecrosis
🔬 Clinical Evidence
Practice reviews 2025 and registry data support expanded use beyond traditional UHMS categories (hyperbaricmedicalsolutions.com).
Complex Traumatic Wounds & Limb Salvage
Reduced fasciotomy rate and edema, faster union in complex crush injuries and traumatic wounds beyond acute phase.
✓ Key Benefits
- •Reduced need for fasciotomy procedures
- •Decreased tissue edema and swelling
- •Accelerated bone and soft tissue healing
🔬 Clinical Evidence
Trauma guidelines 2024 support use in complex cases with established tissue viability concerns (uhcprovider.com).
Complex Skin-Flap Reconstructive Surgery
Rescue of marginally perfused flaps in complex reconstructive procedures, particularly in compromised wound beds.
✓ Key Benefits
- •Improved flap survival rates
- •Reduced surgical revision requirements
- •Better long-term aesthetic outcomes
🔬 Clinical Evidence
Registry data 2024 demonstrates consistent improvement in flap survival across multiple surgical centers (i-jmr.org).
Mild-Moderate Traumatic Brain Injury
Double-blind RCTs show significant cognitive, balance and quality-of-life gains after 40 sessions in persistent post-concussion syndrome.
✓ Key Benefits
- •Improved cognitive composite scores (memory, attention)
- •Enhanced balance and coordination
- •Better quality of life measures
- •Documented functional MRI changes
🔬 Clinical Evidence
Multiple double-blind RCTs demonstrate significant improvements in cognitive and balance testing (neurology.org, nature.com).
Post-Traumatic Stress Disorder (Combat Veterans)
Sham-controlled Israeli RCT shows CAPS-5 score reduction of 30% with durable functional MRI changes in combat veterans.
✓ Key Benefits
- •35% reduction in CAPS-5 PTSD severity scores
- •Improved sleep quality and reduced hypervigilance
- •Enhanced emotional regulation
- •Durable functional brain imaging changes
🔬 Clinical Evidence
Sham-controlled RCT with functional MRI endpoints showing sustained benefits (pubmed.ncbi.nlm.nih.gov, psychiatrist.com).
Long-COVID (Post-Acute Sequelae of SARS-CoV-2)
Multicenter RCTs report improvements in cognition, fatigue & pain up to 12 months in post-acute COVID-19 syndrome.
✓ Key Benefits
- •60% improvement in cognitive function and brain fog
- •Reduced chronic fatigue scores
- •Improved exercise tolerance and VO₂ max
- •Sustained benefits up to 12 months
🔬 Clinical Evidence
Multiple RCTs with 12-month follow-up data showing durable improvements (nature.com, pmc.ncbi.nlm.nih.gov).
Fibromyalgia
2023 BMJ Open meta-analysis shows pain, tender-point count & sleep significantly improved with moderate-quality evidence.
✓ Key Benefits
- •30-50% reduction in VAS pain scores
- •Improved tender-point index and pain threshold
- •Enhanced sleep quality and reduced fatigue
- •Better mood and functional capacity
🔬 Clinical Evidence
Meta-analysis of multiple RCTs showing consistent pain reduction and functional improvement (pubmed.ncbi.nlm.nih.gov, pmc.ncbi.nlm.nih.gov).
Ischemic & Hemorrhagic Stroke (Sub-acute/Chronic)
2024 systematic review suggests motor-score and Barthel-index gains in stroke recovery; larger RCTs currently underway.
✓ Key Benefits
- •Improved motor function scores
- •Enhanced activities of daily living (Barthel Index)
- •Better neurological recovery outcomes
- •Potential for extended therapeutic window
🔬 Clinical Evidence
Systematic review 2024 with ongoing larger RCTs for sub-acute and chronic stroke recovery (pubmed.ncbi.nlm.nih.gov, pmc.ncbi.nlm.nih.gov).
Alzheimer's Disease / Mild Cognitive Impairment
2024 Frontiers review shows small trials with cognitive benefits and good safety profile in mild cognitive impairment and early Alzheimer's.
✓ Key Benefits
- •Improved cognitive assessment scores
- •Enhanced memory and executive function
- •Good safety profile in elderly patients
- •Potential neuroprotective effects
🔬 Clinical Evidence
Small trials showing cognitive benefits with excellent safety; larger studies needed (frontiersin.org, pubmed.ncbi.nlm.nih.gov).
Other Exploratory Areas
Ongoing phase-II trials in migraine, inflammatory bowel disease, sports soft-tissue injury, interstitial cystitis, and retinal ischemia.
✓ Key Benefits
- •Migraine frequency and severity reduction
- •IBD inflammation markers improvement
- •Accelerated sports injury recovery
- •Interstitial cystitis symptom relief
🔬 Clinical Evidence
Multiple ongoing phase-II trials registered 2024-25 across diverse therapeutic areas (trial.medpath.com, frontiersin.org).
HBOT Treatment Protocols
Understanding standardized treatment parameters and what makes HBOT effective.
Treatment Parameters
90-120 minutes breathing 100% oxygen at 1.5-3.0 ATA pressure. Mild ≤1.3 ATA home devices do not replicate therapeutic pressures.
Safety Profile
Low risk: Middle-ear barotrauma (~2%), transient myopia, claustrophobia. Oxygen seizures rare (≈1 per 10,000 sessions).
Credentialing
Look for UHMS-, ECHM- or national accreditation with on-site physician supervision for optimal safety and outcomes.
Insurance Coverage & Access
Understanding coverage patterns and access options across evidence tiers.
UHMS Approved
Routinely covered by major insurers in US/EU when medically necessary with proper documentation.
Strong Evidence
Sometimes covered with prior authorization; varies by insurer and clinical circumstances.
Investigational
Typically research-only or self-pay; access through clinical trials when available.
⚠️ Important Medical Disclaimer
Consult Healthcare Providers: This information is educational and not a substitute for professional medical advice. Always consult qualified clinicians to determine if HBOT is appropriate for your specific condition.
Treatment Parameters Matter: Approved protocols require 90-120 min at 1.5-3.0 ATA breathing 100% O₂. "Mild" (≤1.3 ATA) home devices do not replicate therapeutic pressures.
Evidence Tiers: While UHMS-approved conditions have established efficacy, investigational uses require larger confirmatory studies. Individual results vary based on condition severity and patient factors.
Ready to Explore HBOT for Your Condition?
Learn more about evidence-based benefits and locate UHMS-accredited treatment centers with physician supervision.