Who Should Not Use Hyperbaric Oxygen Therapy?

HBOT is safe for most people, but not everyone. A few medical conditions make treatment risky or impossible. A hyperbaric physician screens every patient before treatment starts, and many conditions that look like barriers can actually be managed.

Absolute Contraindications

Only one condition is a hard stop: an untreated pneumothorax.

A pneumothorax is a collapsed lung. When a chamber pressurizes, a collapsed lung can become a tension pneumothorax, which is a medical emergency. HBOT is never given until the pneumothorax is fully treated and confirmed resolved.

A few chemotherapy drugs also create serious problems. Bleomycin and doxorubicin become toxic at elevated oxygen levels. Disulfiram (Antabuse) and cisplatin require caution and coordination with your oncologist. If you’re currently on chemo, your care team needs to review your drug list before any HBOT starts.

Congenital spherocytosis, a hereditary red blood cell condition, is another absolute contraindication. It’s rare, but patients with this condition don’t respond safely to high-pressure oxygen.

Relative Contraindications (Require Evaluation First)

Relative contraindications don’t rule out treatment. They mean the physician needs more information before saying yes.

Claustrophobia. The chamber is enclosed, which bothers some patients. Many people with claustrophobia complete full treatment courses using mild sedation or by choosing a multiplace (room-sized) chamber. Don’t assume you can’t do it until you’ve talked to the facility.

COPD and emphysema. Significant air trapping in the lungs raises the risk of barotrauma (pressure injury to lung tissue). A physician will review your pulmonary function tests and decide whether treatment is appropriate and at what pressure.

Upper respiratory or sinus infections. Pressure changes during treatment can cause significant pain when sinuses are congested. Treatment is usually postponed until you’ve cleared the infection.

Ear and sinus conditions. A history of ear surgery, perforated eardrums, or poor Eustachian tube function can make pressure equalization difficult. Some patients need ear tubes placed first. This is manageable, not a permanent barrier.

Pregnancy. HBOT isn’t an absolute contraindication during pregnancy, but it’s used only when the benefit clearly outweighs any potential risk. Your OB and the hyperbaric physician will make that call together.

History of seizures. Oxygen toxicity at high pressures can, in rare cases, trigger a seizure. Patients with a seizure history need physician evaluation and sometimes medication adjustment before starting. This doesn’t automatically disqualify you.

Implanted devices. Some cardiac pacemakers and cochlear implants have pressure ratings. The facility will need the manufacturer’s documentation before treating you. Most modern devices are cleared for the pressure ranges used in medical HBOT.

Active viral infection with fever. Treatment is generally postponed until the infection resolves. This is a temporary hold, not a permanent restriction.

How Screening Works Before Treatment

Every patient gets a full medical history review and a physician evaluation before the first session. The hyperbaric physician isn’t looking for reasons to turn you away. They’re looking for risks that can be managed or ruled out.

Many relative contraindications have workarounds. Ear problems can be treated with ear tubes. Medication conflicts can often be timed around HBOT sessions. Claustrophobia can be addressed with sedation.

The physician makes the final call on what’s safe. If a condition truly makes treatment too risky, they’ll tell you, and they’ll explain why. But the majority of patients who come in for evaluation are cleared for treatment.

If you’re unsure whether something in your history is a concern, the right step is to ask at your first consultation. Don’t self-screen yourself out before talking to someone who can actually evaluate your case.

Frequently Asked Questions

Is a pacemaker a contraindication for HBOT? Not automatically. Some pacemakers are pressure-rated for the ranges used in medical HBOT. The facility’s staff will verify your specific device with the manufacturer before treatment.

Can I use HBOT if I have a cold or ear infection? Usually no, but only temporarily. Most facilities postpone treatment until sinus congestion and ear infections clear. Once you’ve recovered, treatment can resume normally.

Does COPD disqualify me from HBOT? Not necessarily. Mild to moderate COPD may be manageable with careful pressure protocols. Severe emphysema with significant air trapping is a higher-risk situation that requires a thorough evaluation.

What happens if I have a contraindication that wasn’t caught before treatment? Medical hyperbaric facilities have physicians and staff on-site during all treatments. If a problem develops, treatment is stopped immediately and the patient is evaluated. This is one reason why getting HBOT at a medically supervised facility — not a wellness spa — matters. See what HBOT is and how to find a provider for more on choosing a qualified facility.

For more on what to expect before your first treatment, read the first session guide.

Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.