Does combining HBOT with steroids help sudden hearing loss?

Yes. The American Academy of Otolaryngology clinical practice guidelines recommend combining high-dose steroids with HBOT for sudden sensorineural hearing loss, initiated within 14 days of onset. The combination outperforms either treatment alone. This is considered standard of care for sudden hearing loss. (Stachler et al., 2012, PMID: 22490619)

Can HBOT replace standard wound care?

No. HBOT is adjunctive to standard wound care, not a replacement. For Medicare coverage, patients must have at least 30 days of standard wound care before HBOT is authorized. Standard care includes debridement, offloading, and vascular assessment. HBOT works alongside these treatments, not instead of them.

What is the Marx Protocol for radiation injury?

The Marx Protocol combines HBOT before and after surgery for osteoradionecrosis and radiation-damaged tissue. The typical protocol involves 20 HBOT sessions before surgery and 10 after, supporting tissue healing around the surgical site. This is an established practice in hyperbaric medicine for radiation injury cases requiring surgical intervention.

What combinations should be avoided with HBOT?

Bleomycin plus HBOT can cause fatal pulmonary oxygen toxicity. Doxorubicin plus HBOT creates cardiac and pulmonary toxicity risk. These are absolute contraindications. Disulfiram is also contraindicated. See the full medications guide for details.

HBOT Combined with Other Treatments: What Works Together

HBOT is rarely used in isolation. For most FDA-approved conditions, it’s one part of a coordinated treatment plan. The research behind HBOT often studied it as an adjunct, not a standalone therapy. Understanding what it’s combined with — and why — explains how it fits into clinical practice.

Sudden Hearing Loss: Steroids Plus HBOT

Sudden sensorineural hearing loss is one of the clearest examples of combination therapy producing better results than either treatment alone.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines, published by Stachler et al. (2012), recommend high-dose corticosteroids as the primary treatment, with HBOT added as an adjunct — particularly for patients who don’t respond fully to steroids alone or who are treated within the optimal window. (PMID: 22490619)

The combination works because each treatment targets a different mechanism. Steroids reduce cochlear inflammation and edema. HBOT increases oxygen delivery to the inner ear, which is supplied by a single end-artery with no collateral circulation. Cochlear hypoxia following the initial injury responds to increased dissolved oxygen in plasma.

The timing constraint is strict: treatment should begin within 14 days of onset for best outcomes. Combination therapy started in the second week still outperforms no treatment. After 14 days, outcomes decline sharply.

Diabetic Wounds: HBOT as Part of Comprehensive Wound Care

Diabetic foot wounds are the highest-volume HBOT indication in the US. But HBOT is an adjunct here, not the primary treatment.

Standard wound care includes debridement (removing dead tissue), offloading (pressure redistribution to allow healing), vascular assessment, and infection control. For Medicare coverage, patients must have completed at least 30 days of standard wound care without adequate healing before HBOT is authorized.

HBOT adds oxygen delivery to ischemic tissue, stimulates angiogenesis, and restores neutrophil bactericidal function. Those effects build on the foundation that standard wound care creates. Running HBOT without debridement and offloading is like fixing a roof leak without clearing the blockage — the underlying problem persists.

Your wound care team manages both components. HBOT sessions happen alongside, not instead of, continued wound care management.

Radiation Injury: The Marx Protocol

For osteoradionecrosis (radiation-damaged bone, typically jaw bone after head and neck cancer treatment) requiring surgical repair, the Marx Protocol is an established clinical approach.

The protocol involves 20 HBOT sessions before surgery to pre-oxygenate radiated tissue, followed by 10 sessions after surgery to support healing in the surgically treated area. Robert Marx’s original research established that radiated tissue has compromised vascular supply that limits surgical healing. Pre-operative HBOT stimulates angiogenesis before the surgical stress, and post-operative sessions maintain oxygen delivery during the healing phase.

This is not experimental. It’s standard practice in hyperbaric medicine for appropriate radiation injury cases.

TBI and Physical Therapy: What Research Has Looked At

For traumatic brain injury and concussion, some studies have combined HBOT with physical therapy, cognitive rehabilitation, or occupational therapy. The reasoning is that HBOT may restore cerebral blood flow to dormant brain regions, and active therapy during that window could reinforce neuroplastic changes.

The evidence for this combination is preliminary. No definitive protocol has been established. These are investigational uses. Insurance won’t cover either HBOT or combination protocols for TBI rehabilitation under most plans.

If you’re considering this for a family member’s TBI, ask about clinical trials at ClinicalTrials.gov. Combination therapy studies for TBI are ongoing, and trial enrollment provides monitored treatment without the out-of-pocket cost.

DCS: HBOT Is the Treatment, Not an Adjunct

For decompression sickness, HBOT isn’t combined with another treatment — it is the treatment. The U.S. Navy Treatment Tables (Table 6 being the most common) structure the full recompression protocol. Adjunctive medications like aspirin or IV fluids may be used to support the patient, but recompression with oxygen is what treats the underlying pathology.

This distinction matters because people sometimes phrase DCS treatment as “HBOT to help with DCS.” HBOT for DCS is standard emergency medicine, not a supplemental option.

Anti-Aging and Biohacking Combinations: No Evidence

People combine HBOT with NAD+ infusions, peptide injections, red light therapy, and other biohacking interventions. None of these combinations have meaningful clinical trial evidence behind them.

HBOT alone has Efrati lab research and other published studies showing effects on aging markers and cognitive function in older adults. The combination protocols are user-reported experiments. For wellness applications, this may be acceptable to some people. For medical conditions, there’s no basis to expect combination with unproven interventions to add benefit.

Combinations That Must Be Avoided

Bleomycin plus HBOT is the most serious contraindication. This combination has caused fatal pulmonary oxygen toxicity. Even years after bleomycin chemotherapy, the lung damage that drug causes doesn’t recover normal oxygen tolerance.

Doxorubicin (Adriamycin) combined with HBOT creates cardiac and pulmonary toxicity risk. Cisplatin also requires careful physician review.

These aren’t theoretical concerns based on molecular pathways. They’re recognized clinical risks with documented adverse outcomes. Any cancer survivor being considered for HBOT needs a complete chemotherapy history reviewed by the hyperbaric physician before treatment begins.

Full medication interaction guidance is in the HBOT Medications and Drug Interactions guide.

FAQ

Can HBOT be combined with intratympanic steroids for sudden hearing loss? Yes. For patients who don’t respond to oral steroids, intratympanic steroid injection is a salvage option. Some audiologists and ENT physicians coordinate intratympanic steroids with an HBOT course. This is within the spectrum of treatments recommended in the AAO-HNSF guidelines.

Does HBOT interact with radiation therapy if I’m currently in a course? This is an active area of clinical discussion. Some research suggests HBOT can sensitize tumor cells to radiation (a potential benefit in cancer treatment), while simultaneously protecting healthy tissue. But the timing and interaction with specific radiation protocols varies. If you’re currently receiving radiation, HBOT should only be used under direct coordination between your radiation oncologist and hyperbaric physician.

Is there research on HBOT combined with stem cell therapy? Some early-stage research has looked at this combination for neurological conditions and wound healing. The combination is investigational. Neither component has strong standalone evidence for most uses in this context, and combining them doesn’t multiply uncertain benefits.

Medical Disclaimer: This page provides general information about how HBOT is used alongside other treatments. It is not medical advice. Treatment combination decisions require coordination among all of your treating physicians, including your primary care provider, specialists, and a qualified hyperbaric medicine physician.