Survey of referral patterns and attitudes toward hyperbaric oxygen treatment among Danish oncologists, ear, nose and throat surgeons and oral and maxillofacial surgeons.

In head and neck cancer patients with late radiation injury, hyperbaric oxygen (HBO) is used for therapeutic or prophylactic reasons against soft-tissue and osteoradionecrosis (ORN). Twenty-nine departments of oncology, ENT, oral and maxillofacial (OMF) surgery were surveyed using the Enalyzer tool (www.enalyzer.com), of whom 21 responded. Data were incomplete in four returns. Within the previous year, 14 departments had referred at least one patient for hyperbaric oxygen therapy (HBOT). There appears to be a generally positive attitude in Danish OMF, ENT and oncology departments towards referral of patients with ORN for HBOT. However, there is an increasing desire for better evidence for its role in head and neck cancer in the prevention and treatment of soft-tissue injury and osteonecrosis following radiotherapy.

Professional attitudes in regard to hyperbaric oxygen therapy for dental extractions in irradiated patients: a comparison of two specialties.

OBJECTIVES: Mandibular osteoradionecrosis (ORN) is a serious complication of radiation therapy. The current use of hyperbaric oxygen therapy (HBO2) to prevent ORN when dental extractions are performed has been called into question. We sought to determine the current acceptability and confidence in this treatment by practitioners from two different specialties. METHODS: We surveyed both hyperbaric medicine physicians and radiation oncologists regarding their views on the use of HBO2 for the prevention of ORN. Separate web-based anonymous surveys were sent via email invitation. These two groups were compared, including statistical analysis using the chi-square test when appropriate. RESULTS: 175 radiation oncologists and 118 hyperbaric medicine physicians participated. Among those not recommending HBO2, lack of evidence was cited by 52% of radiation oncologists and 38% of hyperbaric medicine physicians (chi2 = 5.0, p = 0.03, 95%, CI 1.9% to 25.6%). A majority of radiation oncologists (79%) and hyperbaric medicine physicians (85%) believe it is important that a new randomized controlled trial (RCT) is conducted (chi2 = 1.3, p = NS). CONCLUSIONS: While HBO2 has been used for decades, recent tissue-sparing radiation techniques and advanced surgical techniques are now calling into question the continued use of HBO2 for ORN prevention. Our results demonstrate that there is overwhelming support among responding practitioners for a new RCT.

[Mental distress and quality of life in tinnitus patients]. / Psychische Belastung und Lebensqualität bei Tinnituspatienten.

BACKGROUND: Tinnitus is a disease with a high prevalence that is often combined with psychiatric comorbidity. The aim of this study was to identify the dimensions of quality of life in which tinnitus patients are especially affected, and how these affections change during a therapy, including a hyperbaric oxygen therapy. MATERIAL AND METHODS: 120 patients suffering from tinnitus were examined at 3 time points: at the beginning (t1) and the end (t2) of a 2-week hyperbaric oxygen therapy, and 4 weeks later (t3). The following questionnaires were adopted: Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, and the quality of life instrument EORTC QLQ-C30. RESULTS: Compared with the general population, tinnitus patients were impaired in all areas of quality of life. The greatest differences were found in the scales Social, Cognitive, Emotional and Role Functioning and in the field of financial difficulties with effect sizes of about 1.5. During the therapy, the scores improved, reaching roughly the middle between the initial patients' scores and the values of the general population. The directly assessed subjective improvement due to the therapy was only marginally correlated with the differences in the questionnaires. CONCLUSION: Since there was no control group without hyperbaric oxygen therapy, the results do not justify conclusions about the effectiveness of this therapy. However, the findings document multiple impairments of the patients (especially psycho-social disturbances) and show hints for supportive offers.

Effects of hyperbaric oxygen therapy on quality of life in maxillofacial patients with type III osteoradionecrosis.

PURPOSE: Over a 4-year period, 18 patients with type III osteoradionecrosis that developed an average of 55 months after radiotherapy treatment for head and neck cancers were referred for hyperbaric oxygen therapy (HBO(2)). MATERIALS AND METHODS: Participants completed a questionnaire battery before and after HBO(2), including the European Organization for Research and Treatment of Cancer (EORTC) Core 30, the EORTC Head and Neck 35, and the Medical Outcomes Short Form 36. RESULTS: The EORTC Core 30 questionnaire indicated significant improvements in "emotional functioning" and "insomnia" (P ≤ .01 and P ≤ .01). An improvement also was found in the "social eating" (P ≤ .01) and "teeth" (P ≤ .01) domains of the EORTC Head and Neck 35 questionnaire. These beneficial outcomes might be explained in part by the social environment of being in a specific treatment group with similar patients. However, the Medical Outcomes Short Form 36 indicated a significant decrease in "social functioning" (P ≤ .01). The patient group in this study did not undergo any surgical intervention between the 2 time points and no other interventions could be connected with the improvements, particularly in relation to "teeth." In addition, clinical follow-up confirmed the stabilization of the patients' clinical conditions. CONCLUSIONS: The findings of this study support the hypothesis that HBO(2) has positive physiologic and psychological effects on some factors for this patient group.

[Beliefs of Croatian surgeons and internists on hyperbaric oxygenation--a preliminary report]. / Stavovi hrvatskih kirurga i internista o hiperbaricnoj oksigenaciji--prethodno priopcenje.

BACKGROUND/INTRODUCTION: Hyperbaric oxygenation (HBO) has been accepted in many countries as a method of treatment in selected indications, but in Croatia it is still perceived with skepticism. OBJECTIVE: To determine beliefs, knowledge, and possible experience of Croatian surgeons and internists with HBO. SUBJECTS AND METHODS: An anonymous questionnaire was applied to test surgeons (N=56; 45%) and internists (N=68; 55%), employed in general hospitals in Zadar, Sibenik, Split, and Dubrovnik, Republic of Croatia. We believed that the subjects had been previously exposed to information campaigns about HBO and its clinical applications, and should have been informed about the method at a level enabling correct establishment of indications and routine usage of HBO in clinical practice. RESULTS: The majority of study subjects (N=66; 53%) had very little or no information at all about HBO and half of them (N=50; 40%) had no experience in its application. Almost all (N=123; 99%) subjects considered the method valuable in the treatment of decompression sickness, 56 subjects (45%) considered the method efficient in carbon monoxide poisoning, 31 (25%) in cerebral arterial gas embolism, 87 (70%) in problem wounds, and 70 (56%) in gas gangrene. The only statistically significant difference between the two groups of subjects was recorded in case of cerebral arterial gas embolism (chi2 = 7.26, P = 0.007), which was recognized as an indication for HBO by more internists (N=23) than surgeons (N=8). DISCUSSION: Insufficient understanding of HBO amongst Croatian surgeons and internists is probably the consequence of several factors, of which most important probably are insufficient curricula of undergraduate studies and residencies, as well as administrative obstacles. A small number of responders and polled hospitals necessarily resulted in a significant bias, so additional studies are necessary to shed more light on the issue.

Case report: successful use of hyperbaric oxygen therapy for a complete scalp degloving injury.

We report a case of a complete scalp degloving injury in a 43-year-old previously healthy, tobacco-using female whose hair was caught in a tractor power take-off causing an instantaneous total scalping injury. Microsurgical replantation was started 4 hours after injury with the surgical procedure lasting 4 hours. Only the superficial temporal arteries were reanastomosed with no venous anastomosis possible. Hyperbaric oxygen (HBO2) treatment at 2.5 atmospheres absolute (ATA) for 90 minutes was administered immediately after surgery due to duskiness of the flap. Further HBO2 treatments were administered twice daily for seven days and then once daily for 30 days. Additionally, leech therapy was used for the first ten postoperative days. The patient's right auricle and most of the left auricle were completely lost. Despite the tenuous vascular inflow and initially absent venous drainage, at 3 month follow-up there was reepithelialization of her scalp except for an area of granulation tissue in the occipitoparietal area. At one year follow-up the area of granulation tissue was reduced, but there was no detectable hair growth or nerve function. We propose that HBO2 may facilitate tissue survival in scalp degloving injuries in the face of incomplete surgical revascularization.

An exploration of patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber.

AIMS AND OBJECTIVES: To examine patients' memories and experiences of hyperbaric oxygen therapy in a multiplace chamber of a hyperbaric medicine unit in Australia. BACKGROUND: There is minimal literature available documenting patients' feelings and memories of hyperbaric oxygen therapy, particularly in a multiplace chamber. DESIGN: Exploratory. METHODS: A convenience sample of seven non-emergency patients was interviewed separately at the conclusion of their multi-session therapy. A semi-structured approach elicited in-depth information regarding their experiences and memories of the hyperbaric oxygen therapy. Interviews were 30-45 minutes long and audiotaped for transcription and analysis. Field notes were also used to note non-verbal cues and other observations not evident from the audio material. Data collection ceased when data saturation was evident from the interviews. Interview transcripts were examined using a content analysis approach, with textual coding and thematic development. RESULTS: Issues derived from the data included: the uncertainty of the treatment; the noise and cold of the chamber; the discomfort of the mask or hood; and the boredom. Participant responses to the therapy related to previous noxious experiences and the individual's personality. CONCLUSIONS: This information was used to examine ways of reducing any negative feelings and experiences associated with hyperbaric oxygen therapy, thus improving the service provided to patients. RELEVANCE TO CLINICAL PRACTICE: Identification of these stressors and related issues may also enable subsequent development of a risk-stratification instrument to predict patients who do not complete treatment.

A prospective study: hyperbaric oxygen therapy in diabetics with chronic foot ulcers.

Research suggests that hyperbaric oxygen therapy may have beneficial effects on ulcer healing and amputation rates in diabetic patients. This paper describes the design of a study that is evaluating its effects on chronic diabetic foot ulcers.

Hyperbaric oxygen (HBO2) in tinnitus: influence of psychological factors on treatment results?

UNLABELLED: HBO2 for subjective tinnitus has never been objectified, yet it is still advocated by many institutions. We analyzed the therapeutic effect of HBO2 treatment in the context of accompanying factors, especially focusing on the patients' attitude towards HBO2 prior to therapy. METHODS: 360 patients suffering from tinnitus were investigated in this study. They were randomized into 2 hyperbaric treatment protocols, one at 2.2, the other at 2.5 bar, 60 min bottom time each. All patients were asked to fill in a questionnaire (social and medical history, tinnitus characteristics, pre-HBO2 duration oftinnitus, prior therapy, pre-treatment expectation, accompanying symptoms) immediately before and one month after HBO2 treatment. The subjective impact of tinnitus on daily life was assessed using a score from 1 to 10 prior to HBO2 and one month after the treatment. RESULTS: 12 patients (3.3%) experienced complete remission of tinnitus, in 122 (33.9%) the intensity lessened, and 44 (12.2%) had a subjectively agreeable change of noise characteristics. 157 (43.6%) stated no change and 25 (6.9%) experienced deterioration. There was no statistically significant difference between the two hyperbaric protocols (p > 0.05). Out of 68 patients with positive expectation towards HBO2 therapy 60.3% stated that the tinnitus had improved whereas out of the patients who underwent therapy with indifferent (N = 271) or negative expectations (N = 21) only 47.2% and 19%, respectively, reported an improvement. The influence of both positive and negative anticipation on the outcome was statistically significant (p < 0.05). CONCLUSION: The therapeutic effects of HBO2 on subjective tinnitus might be greatly due to psychological mechanisms triggered by the attitude of the patient towards HBO2 therapy prior to the treatment.

Personality patterns of anxiety during occupational deep dives with long-term confinement in hyperbaric chamber.

Extreme environments are generally thought to be stressful situations. Occupational deep diving inflicts periods of long-term confinement in hyperbaric chambers and high-pressure exposure on divers. Such extreme environmental conditions have been demonstrated to produce acute responses of anxiety in individual divers. Although these studies have mentioned personality as a factor explaining why some divers reported an increase in ratings of anxiety, the role of personality traits still remains unclear. The present study examines the possible role of personality traits in the development of diving anxiety. Results confirm that diving anxiety remains at the individual level and relatively transient and suggest that personality factors, such as low self-control and emotional instability, that reflect an incapacity to control and express tension in an appropriate manner would play a crucial role in the occurrence of diving anxiety.

An alternative oxygen supply technique for the difficult patient.

A modified oxygen delivery system was developed for a patient too claustrophobic for the monoplace chamber or the hood in the multiplace chamber. The adaptation delivered O2 through the patient's tracheostomy by means of a soft cervical collar, a pediatric tracheostomy cuff, and a T-tube.

Assessment of the magnitude of anxiety in adults undergoing first oxygen treatment in a hyperbaric chamber.

The purpose of this study was to determine the magnitude and specific foci of anxiety experienced by patients receiving their initial hyperbaric treatment. The Spielberger State-Trait Inventory questionnaire and a personal interview were administered to 24 patients to determine anxiety levels. Upon arrival at the hyperbaric clinic and prior to any type of health teaching, the State and Trait questionnaire was administered to the patients. One hour prior to the treatment, the State questionnaire was repeated to determine any significant changes in anxiety levels. No significance was found in anxiety levels between pre-health and pre-treatment. The Trait questionnaire revealed that this specific group of patients, regardless of the circumstances, felt they were not very anxious individuals. Post-treatment, the State questionnaire was administered again and these anxiety levels did differ significantly from the pre-health and pre-treatment levels. The findings indicate the need to continue to validate clients' perceived needs during hyperbaric treatment, which will help direct future nursing practice.

Hyperbaric oxygen and the cancer patient: a survey of practice patterns.

A questionnaire was sent to 179 clinical hyperbaric medicine facilities to survey treatment policies and referral patterns for patients with a history of malignancy. Eighty-five surveys were returned. Most respondents indicated that they would accept patients with a history of malignancy for either adjuvant or emergent hyperbaric oxygen (HBO). Depending on specific circumstances, from about one third to one half of respondents believed that such patients should be informed of a theoretical potential for tumor acceleration or reactivation. An overwhelming majority had not personally attended nor had they been told by colleagues of cases of patients whose malignancy had been activated or accelerated by HBO. A large majority felt that referring physicians did not believe that HBO was carcinogenic, and that referrals were not prevented by such concerns. Seven percent believed that HBO is potentially carcinogenic. Forty-two percent of respondents felt that they might be at risk for malpractice litigation if a patient had reactivation or acceleration of a malignancy. Among respondents to the questionnaire, there is a consensus that HBO does not have cancer-promoting or accelerating properties.