Hyperbaric Oxygen

Hyperbaric treatments increase vascularity to the surgery site, increase the elasticity of the skin and circulating stem cells to help with healing, and can improve blood supply to grafts when they are needed.

What is Hyperbaric Oxygen Therapy (HBOT)?

HBOT is a form of wound healing treatment during which the patient sits in a pressurized chamber and breathes pure oxygen.

Who is recommended to do HBOT?

Anyone is welcome to try Hyperbaric, as there are no adverse effects, but it is only asked of a patient if they have had two or more previously failed repairs, or if they have a history of difficult wound healing. If our doctors recommend HBOT for you or your son, they will tell you. 

How do I get set up with a hyperbaric facility, and how do I know which one to choose? 

When it comes to where to get your HBOT completed, the choice is ultimately yours. Hyperbaric facilities near you can be found with a quick Google search. It is up to you to find a location that best fits your needs (nearest to your home/school/work). Make sure the treatments they provide are within our protocol**, and discuss with them insurance coverage, and whether they have scheduling availability to accommodate your needs. Most facilities will have the patient come in for a consultation, and familiarize him with the process and equipment. If you would prefer to use facilities near our office, we can provide you with a list of ones we have worked with.  If you’re having any difficulties finding facilities in your area, there is always the option of staying in the Dallas area so that you can receive treatments at local facilities, some of whom offer hotel discounts for those out of the area needing 10 or more treatments. We are not familiar with all the Hyperbaric Centers across the nation, though we do hear from parents that some are wonderful. Other families have found it easier to get treatments near Dallas while they are in town for surgery. We also work with facilities that offer private pay options for those without insurance or who have plans that refuse to cover HBOT. Once you have made your ultimate choice on where to receive treatment, we will send a thorough referral to your selected facility.

**Our required protocol: 60 minute treatments which do not include the time it takes for compression and decompression. Most facilities take 15 minutes before and after the treatment to compress and decompress the chamber, for a total of 90 minutes. Additionally, the chamber should be compressed to 2.0 atmospheric pressure (atm). Some facilities only compress to 1.3 or 1.5atm, which the doctors have not found as effective. Lastly, they need to provide 2 ‘air breaks’ for older children, which means going down from 100% oxygen to 21% oxygen (room air) for 5 minutes twice each dive to help with stem cell formation, which may help in healing.

Mono-Chamber Hyperbaric Facility:

How many treatments are necessary, and when do I get them? Can I have multiple per day? 

The number of hyperbaric treatments varies, but generally you can expect to receive 10 to 20 dives after surgery. This depends on the type of repair that you or your son is having, as well as his previous medical history. Generally, if the surgical plan is to graft then you can anticipate 20 post-operative dives, otherwise anticipate 10 post-operative dives. In some cases, pre-operative treatments may also be recommended. You may have 1-2 dives per day, mostly depending on insurance allowance and facility availability. You’ll need to get your treatments done as close to surgery as possible. Some patients are even able to start their postoperative treatments the day of surgery, or typically, the day directly following surgery. The further away from surgery day you start, the less effective these treatments are. Therefore, you want to get as many treatments, in as direct succession as possible, as soon after surgery as you are able.

Will my insurance cover HBOT?

We submit extremely thorough referrals to all HBOT facilities, and maintain a high success rate with insurance companies for approval. However, there are never any guarantees, and many families have to make adjustments. If your insurance company denies treatment, we can also help with other documentation for the HBOT center's appeal. In some circumstances, it is more difficult to receive treatments prior to surgery compared to after surgery. If that’s the case, contact us and we can arrange HBOT to begin right after surgery at a local facility. We can document tissue changes during surgery that  often help with urgent/emergency coverage. In these circumstances, we typically recommend staying in the Dallas area near our local facilities that are very familiar with insurance approval for hypospadias. Twice a day treatments for the first day or 2 after surgery are recommended, then once per day until the 10-20 dives are complete. You can continue the treatments until complete, or until heading home where he would finish the remainder of the treatments at the facility you’ve identified near your home. Most HBOT facilities are closed over the weekend. Finally, it is important to know you cannot fly on an airplane the same day as an HBOT dive. 

Challenges due to age or tolerance:

If you have an older child who isn't tolerating the hyperbaric chambers like you thought he would, or if your child is less than four years old: We recommend giving cetirizine (like Zyrtec) and Afrin nasal spray before each treatment. Contact us if you need help with dosing instructions. It helps reduce discomfort when children are not yet able to clear their ears. For older boys, teaching them how to ‘pop’ their ears like you would on an airplane is helpful, and you can teach younger boys to make “shark bites” - snapping their jaws which can help clear their ears. For younger boys (usually those less than 2 1/2 years), ear tubes are recommended to help decrease risk for ear pain during HBOT dives. Local Ear Nose Throat (ENT) doctors can be found with a Google search or by calling the number on the back of your insurance card to see what providers and clinics are in network with your specific insurance. We recommend getting ear tubes placed several weeks prior to surgery. Ear tubes usually take only a few minutes for specialists to place under mild sedation. 

Additional questions or concerns about HBOT?

If you have questions about Hyperbaric Oxygen Therapy, please direct them to Bri, at care@hypospadias.com