HYPERBARIC OXYGEN THERAPY(HBOT) Definition: the medical use of oxygen at a level higher than atmospheric pressure.therapy involves the intermittent inhalation of 100 per cent oxygen in chambers pressurized above one atmosphere absolute. The treatment duration and number of sessions required depend on the reason for HBOT. Each treatment duration can vary from 45 to 300 minutes, although most treatments are in excess of 90 minutes, for a variable number of sessions

Therapeutic principles increase oxygen delivery to tissue. Several therapeutic principles are made use of in HBOT:  The increased overall pressure is of therapeutic value through - increase partial pressure of oxygen in the tissues of the body that is much higher than those achievable while breathing pure oxygen at normobaric conditions (i.e. at normal atmospheric pressure). -increased oxygen transport capacity of the blood. Oxygen transport by plasma, is significantly increased using HBOT as the stimulus(Under normal atmospheric pressure, oxygen transport is limited by the oxygen binding capacity of hemoglobin in red blood cells and very little oxygen is transported by blood plasma. Because the hemoglobin of the red blood cells is almost saturated with oxygen under atmospheric pressure, this route of transport cannot be exploited any further). -the oxygen is in solution, it can reach physically obstructed areas where red blood cells cannot pass, and can also enable tissue oxygenation even with impaired hemoglobin oxygen carriage, such as in carbon monoxide poisoning and severe anemia

 exposure to hyperbaric oxygen (HBOT) mobilizes stem/progenitor cells from the bone marrow by a nitric oxide (·NO) -dependent mechanism.This mechanism may account for the patient cases that suggest recovery of damaged organs and tissues with HBOT , The therapeutic effects of HBO are: Hyper oxygenation causes (i) Immune stimulation by restoring WBC function and enhancing their phagocytic capabilities and (ii) Neo-vascularization in hypoxic areas by augmenting fibroblastic activity and capillary growth. This is useful in radiation tissue damage and other problem wounds. Vasoconstriction reduces edema and tissue swelling while ensuring adequate Oxygen delivery. Bactericidal for anaerobic organisms & inhibits growth of aerobic bacteria at pressures > 1.3 ATA.. Reduces half-life of Carboxyhemoglobin from 4 to 5 hours to 20 minutes or less and is the treatment of choice for Carbon Monoxide poisoning in fire victims. Mechanical effects: Direct benefit of increased pressure helps reduces bubble size in Air Embolism and Decompression Illnesses.

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Reactivates “sleeping cells” in the penumbra region around central dead neuronal tissue. This is the basis of its use in neurological conditions. It also reduces adherence of WBCs to capillary walls and maybe useful in acute brain and spinal cord injury

Indications 1. 2. 3. 4. 5. 6. 7.

Air or gas embolism Carbon monoxide poisoning Carbon monoxide poisoning complicated by cyanide poisoning Clostridal myositis and myonecrosis (gas gangrene) Crush injury, compartment syndrome, and other acute traumatic ischemias Decompression sickness Enhancement of healing in selected problem wounds 1. (Diabetically derived illness, such as diabetic foot diabetic retinopathy, diabetic nephropathy) 8-Exceptional blood loss (anemia) 9-Intracranial abscess

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10.Necrotizing soft tissue infections (necrotizing fasciitis) 11.Osteomyelitis (refractory) 12.Delayed radiation injury (soft tissue and bony necrosis) 13.Skin grafts and flaps (compromised) 14.Thermal burns Other reported applications include: 1. Autism.Some studies show that HBO cause significant improvement in the children's behavior immediately after treatment sessions other studies found that hyperbaric oxygen therapy does not have a significant effect on symptoms of autism. 1. Cerebral Palsy 2. Epidural abscesses. 3. Certain kind of hearing loss. 4. multiple sclerosis. 5. Radiation-induced hemorrhagic cystitis. 6. Inflammatory bowel disease. 7-Psoriasis.

Methods of administrations: Systemic Hyperbaric Oxygen Pressurization  the patient is entirely enclosed in a pressurized chamber and breathes oxygen at a pressure greater than one atmosphere (the pressure of oxygen at sea level).  Treatment may be carried out either in a monoplace (one person) chamber pressurized with oxygen or in a larger multiplace (two or more person) chamber pressurized with compressed air, in which case the patient receives pure oxygen by mask, head tent, or endotracheal tube  Hyperbaric chambers may be (according to construction)

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1- Hard shelled :The traditional type of hyperbaric chamber used for HBOT -Such chambers can be run at absolute pressures as much as 6 bars (87 psi), 600,000 Pa. -hospitals, and dedicated recompression facilities typically operate these. -hard chamber consist of ** a pressure vessel made of steel, aluminum with the view ports (windows) made of acrylic. **one or more human entry hatches ,the airlock that allows human entrya separate chamber with two hatches, one to the outside and one to the main chamber, which can be independently pressurized to allow patients to enter or exit the main chamber while it is still pressurized and a small airlock for medicines, instruments, and food. **Glass ports or closed-circuit television that allows technicians and medical staff outside the chamber to monitor the patient inside the chamber. **A A carbon dioxide scrubber—consisting of a fan that passes the gas inside the chamber through a soda lime canister.A control panel outside the chamber to open and close valves that control air flow to and from the chamber, **intercom or walkie-talkie allowing two-way communication 2- soft" chambers that can operate at between 0.3 and 0.5 bar (4.4 and 7.3 psi) above atmospheric pressure. ** consist of A urethane-coated, nylon-bonded flexible acrylic pressure vessel with steel-weld technology.A full-length dual zipper-sealed opening ** An over-pressure valve, if oxygen is fed into a small mask and expired gas has to be circulated toward the end of the chamber and out through the pressure regulators ***Hard chambers and soft chambers should not be considered equivalent in regards to efficacy and safety as they are different in many aspects.

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Oxygen supply:  Both patients and medical staff inside the chamber breathe from either "oxygen hoods" – flexible, transparent soft plastic hoods with a seal around the neck similar to a space suit helmet – or tightly fitting oxygen masks, which supply pure oxygen and may be designed to directly remove the exhaled gas from the chamber to prevent the build up of oxygen, which could present a fire risk.  During treatment patients breathe 100% oxygen most of the time to maximize the effectiveness of their treatment, but have periodic "air breaks" during which they breathe room air (21% oxygen) to minimize the risk of oxygen toxicity.  Attendants may also breathe oxygen to reduce their risk of decompression sickness. Home and out-patient clinic :treatment There are several sizes of portable chambers, which are used for home treatment. These are usually referred to as "mild personal hyperbaric chambers", which is a reference to the lower pressure (compared to hard chambers) of soft-sided chambers. (FDA) approved chambers for use with room air are available in the USA and may go up to 4.4 pounds per square inch (psi) above atmospheric pressure

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 Due to the high circulation of air through the chamber, the total concentration of oxygen in the chamber never exceeds 25% as this can increase the risk of fire.  Oxygen is never fed directly into soft chambers but is rather introduced via a line and mask directly to the patient.  FDA approved oxygen concentrators for human consumption in confined areas used for HBOT are regularly monitored for purity (+/- 1%) and flow (10 to 15 liters per minute outflow pressure).An audible alarm will sound if the purity ever drops below 80%. Topical Hyperbaric Oxygen Therapy a technique of delivering 100% oxygen directly to an open-moist wound at a pressure slightly higher than atmospheric pressure. It is hypothesized that the high concentrations of oxygen diffuse directly into the wound to increase the local cellular oxygen tension, which in turn promotes wound healing

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Multiplace champer

Monoplace chamber (hyperbaric healing institute, kansas, US

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Advantages of HBO : Safe therapy with very few and minor side effects Addition of HBO obviates the need for frequent surgical procedures, promotes healing and early mobilization of the patient. Reduces length of hospitalization and thereby overall treatment and rehabilitation costs Only treatment available in some indications. Emerging role in indications which have lifetime disabilities HBO in Decompression Sickness  Decompression sickness (DCS) occurs mainly in scuba divers, when inert gas (mainly nitrogen) comes out of solution during ascent and decompression, forming bubbles in the capillaries and tissues. Doppler studies have shown that most divers have venous bubbles even on decompression, even when conservative dive tables are followed, but these smaller bubbles are not necessarily pathological  Symptoms depend on the location of the bubbles, and include fatigue, joint pains, rash, neurological and cardio-respiratory symptoms, coma and death, and occur due to physical distortion, vessel occlusion, clotting and immune changes. Predisposing factors include dehydration, injury, exertion at depth and cold exposure  Since the 1930s, HBO has been the definitive treatment for DCS,. HBO recompresses bubbles and forces gas back into solution for a more controlled ascent. Inert nitrogen is replaced by rapidly-metabolized oxygen, and bubbles move either to the lungs where they are excreted, or to smaller vessels where obstruction is less important, and surface tension forces eventually collapse the bubbles. HBO also counteracts platelet and leukocyte activation and endothelial interactions. recommend rapid treatment at 2.8 ATA, repeated up to ten times if symptoms persist 1-SUDDEN SENSORINEURAL HEARING LOSS Definition Pathophysiology-Treatment ROLE OF HBOT IN SSNHL:  Principle: hearing loss and tinnitus may result from an hypoxic event in the cochlear apparatus, and that HPO may be able to reverse that oxygen deficit ( early as 1976, Fisch and others measured perilymphatic oxygen tension (measure by oxygen electrode inserted in the perilymphatic space) found to be decreased in some patients with SSNHL

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 administration of 100% oxygen greater than one atmosphere absolute (ATA) 1.5 and 3.0 ATA to deliver a greatly increased partial pressure of oxygen to the tissues. (HBOT of 2.0 atmosphere absolute (ATA) can increase partial pressure of oxygen in perilymph of healthy inner ears to 318% of that of normals)

 protocol HBOT therapy **primary therapy for SSNHL in some centers in Japan and Turkey **an adjunct to medical therapies. ** Many centers in Europe routinely use HBOT for secondary therapy in SSNHL treatment failures -Secondary HBOT after failure of systemic steroid and antiviral therapy may be associated with hearing gains in some patients. In patients who have no other salvage option, HBOT should be considered --The best hearing recovery on auditory brainstem response and VIII compound action potentials have been achieved by a combination of HBOT and steroids. -for people with early presentation of ISSHL, the application of HBOT significantly improved hearing loss,. There was no evidence of a beneficial effect of HBOT on chronic presentation of ISSHL and/or tinnitus and they did not recommend use of HBOT for this purpose.

: HBOT protocol” performed every weekday for 2 weeks(10 cessions ,each 60 minute), with PTA measured once a week. HBOT was continued when any improvement in audiometric thresholds was recognized by the end of 10 sessions.

II.TINNITUS The pathogenesis of tinnitus is still not well understood. In pathogenesis of tinnitus, several causes have been postulated, including vascular disturbances (thromboembolic events, vasoconstriction, hypertension, blood hyperviscosity), viral infection, intracochlear membrane damage, autoimmune processes -Variety of treatments have been proposed, and still today, many different treatment regimens………… - In the cochlea, two types of metabolism exist, i.e. aerobic oxidative metabolism for the vascular stripe and anaerobic for the organ Corti. HBO is the only known method to raise oxygen level of the perilymphatic inner ear fluid. - role: 1-. protection of sensorineural cells whose metabolism and blood flow has slowed down by increasing intra-cochlear pO2 and restoration of oxidative metabolism in the vascular strip.

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2-HBO also improves haemorrheology and contributes to improved microcirculation by lowering the blood viscosity and improving the erythrocyte elasticity -

Some studies show that HBO can reduce tinnitus even if it has been present for a long time. In their opinion, in the treatment of tinnitus, it should be applied after exhaustion of every available method of treatment

III. MÉNIÈRE'S DISEASE  Some studies show that continuous variations in pressure (from 1.7 to 2.2 ATA; alternobaric oxygen therapy: ABOT) were used to decrease endolymphatic hydrops, the typical histopathological substrate of Ménière's disease by increasing hydrostatic pressure and mechanical stimulation of the endolymphatic flow toward the duct and the endolymphatic sac, which produces a consequent increase in the dissolved O2 content in the labyrinth liquid, which should contribute to recovering cell metabolism and restoring cochlear electrophysiological function to normal  at the end of the follow-up period, patients treated with ABOT had significantly fewer vertiginous episodes and improved PTAs and tinnitus compared to the controls. The results support the use of ABOT as a valid alternative to drugs in the long-term treatment of Ménière's disease

IV. MALIGNANT OTITIS EXTERNA (MOE). Patients usually present with severe otalgia, otorrhoea and hearing loss. There are three stages in malignant otitis externa. - In stage I disease, the cardinal clinical features include persistent purulent otorrhoea, otalgia and infected granulation tissue in the floor of the external auditory canal with no facial nerve palsy. -In stage II disease the process extends into the soft tissues leading to facial nerve palsy and skull base osteomyelitis and involves the posterior cranial nerves XI and XII as they exit their respective foramina. In stage III disease, intracranial extension occurs along with the stage II signs Treatment  Treatment of necrotizing external otitis includes correction of immunosuppression (when possible), Strict control of diabetes mellitus. local treatment of the auditory canal, long-term systemic antibiotic therapy and, in selected patients, surgery.  Local treatment of the auditory canal includes meticulous cleaning and debridement plus topical application of antimicrobial agents (antibiotics and others). Sequestra and other necrotic tissue should be removed. Initially, treatment may include the application of antimicrobial impregnated dressings to the canal. An antipseudomonal agent should be used first; if necessary, the agent can be changed on the basis of the culture results. As in other infections involving bone, long-term administration of systemic antibiotics is the main stay of treatment  Hyperbaric oxygen, an adjunct to antibiotic therapy, is believed to increase the ability of polymorphonuclear cells to fend off pathogenic bacteria. However, complexity of administration often limits the use of hyperbaric oxygen therapy

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 Treatment failure occur due to tissue hypoperfusion and hypoxia where the use of (HBO) increases wound PO2 levels, enhances phagocytic oxidative killing of aerobic micro-organisms, promotes angioneogenesis and osteoneogenesis. Treatment consists of 100% O2 given for 90 minutes at 2.5 ATA five days a week for 4 weeks asanadjuvanttherapy

V. OSTEORADIONECROSIS 

complication of the use of radiation therapy in the treatment of head and neck cancer. ORN consists of necrotic soft tissue and bone that fail to heal spontaneously and do not respond to local care over a period of 6 months. Radiation induces tissue

 In theory, hyperbaric oxygen therapy (HBO) may stimulate monocytes and fibroblasts function and

collagen synthesis, and may increase vascular density. In practice, uncontrolled studies showed recovery rates from Osteoradionecrosis of 15% to 45% with HBO alone, and 20% to 90% with HBO combined to surgery

BELL’S PALSY  Known causes of facial paralysis include stroke, trauma (e.g. laceration, fractures), neoplasm

(metastatic lesions, parotid tumors), and congenital defects. Bell's palsy, however, is an acute idiopathic condition involving damage to the seventh cranial facial nerve. It is the most prevalent form of facial paralyses and usually presents unilaterally. Traditionally thought to be a diagnosis of exclusion, unilateral Bell's palsy can be positively identified based on clinical assessment, without performing expensive tests  TTT: -Antiviral agents (if infectious processes are suspected to be the cause of paralysis) and corticosteroids are usually prescribed to treat Bell's palsy. Research has shown that patients who receive such treatment within three days of symptom onset experience higher recovery rates than those who start therapy after four or more days - physical therapy, which can be used alone or in conjunction with surgery -Other nonsurgical treatments to combat the effects of facial paralysis include mime therapy, in which patients measure progress by the symmetry of their smile and judgment of their smile by others, myofeedback, hyperbaric oxygen treatments, which have been shown to be more effective than treatment with prednisone -From physiopathological point of view it is logical to apply HBO in the treatment of BP (Bell’s palsy). Vasoconstrictive, antioedematous effects and better perfusion of HBO have inspired 1984(Racic et al.) to apply HBO in the treatment of BP. In spite of high efficiency of this kind of treatment confirmed with double blind controlled study this method is not generally adopted -Study done Between the 1995 and 2001, by Gosovic G., Gosovic S. on 16 patients with Bell’s Palsy treated by HBOT without using other conservative measures even prednisone showed that the percentage of cured patients with HBO and specially the average interval for a full recovery is significantly shorter than by others methods of conservativetreatments X. HEAD AND NECK MALIGNANCIES  Tumor hypoxia presents in at least one third of cancers in the clinical setting

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Hypoxia of tumors exists due to restrictions in the oxygen delivery by perfusion and/or diffusion based on inadequate microcirculatory function, and in the oxygen transport due to tumor-associated anemia.  HBO has been proposed to reduce tumor hypoxia by increasing the amount of dissolved oxygen in the plasma ,HBO has been shown to improve the radiation response of many solid tumors

Contraindications  The only absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax.  Patients should not undergo HBO therapy if they are taking or have recently taken the following drugs: more significant toxic effects from HBO therapy.

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Doxorubicin (Adriamycin) – A chemotherapeutic drug. Cisplatin – Also a chemotherapeutic drug. Disulfiram (Antabuse) – Used in the treatment of alcoholism. Mafenide acetate (Sulfamylon) – Suppresses bacterial infections in burn wounds.  The following are relative contraindications: Diseases that may result in air-trapping within the lungs constitute relative contraindications because they may predispose the patient to pneumothorax or arterial gas embolism.

 Upper respiratory infections and previous ear surgery that may indicate the patient will have difficulty with pressure equalization

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High fevers . Emphysema with CO2 retention History of thoracic (chest) surgery – Malignant disease: Middle ear barotrauma. Pregnancy is a relative contraindication

Patients with seizure disorders should be treated cautiously because HBO exposure may potentiate seizures  Patients with claustrophobia or psychiatric conditions may not tolerate the HBO therapy environment. The contraindications can be summarized in the following table: Condition Rationale Anxiety Claustrophobia Pneumothorax

Gas emboli, pneumomediastinum Pneumoperitoneum Tension (pneumothorax) Subcutaneous emphysema

History of spontaneous pneumothorax

Increased lung bleb incidence (pneumothorax)

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Chronic obstructive pulmonary disease

Increased oxygen intolerance

Pneumocystic carinii pneumonia

Increased oxygen intolerance

Seizure disorders

Increased risk of seizures

Pregnancy*

Questionable fetal teratogen

Upper respiratory infection

Barotraumas to sinus/ear/lung

Hyperthermia

Decreased threshold for oxygen-induced seizures

Hereditary spherocytosis Optic neuritis

Increased haemolysis Questionable - Increased optic nerve pathology

Malignant tumours (as sole ttt.).

Questionable - Increased vascularity for tumours

Acidosis

Decreased threshold for oxygen seizures

Complications of HPO therapy Safety of hyperbaric oxygen (HBO) therapy has been the object of multiple reports showing that side effects are related to both high pressure (source of barotrauma i.e. compression manifestations and decompression illness) and oxygen toxicity 1-

OXYGEN TOXICITY: The clinical settings in which oxygen toxicity occurs are broadly divided into two groups; one is in which the patient is exposed to very high concentrations of oxygen for short duration, like in HBOT, and the second is in which lower concentrations of the gas are used but for longer duration. These two can result in the so called ‘acute’ and ‘chronic’ oxygen toxicity, respectively. The acute toxicity has predominant CNS effects, while chronic toxicity has predominant pulmonary effects clinical manifestations of oxygen toxicity: 1-Central nervous system toxicity e.g twitching of perioral and small muscles of the hand ,vertigo and nausea convulsions. 2- Pulmonary toxicity –.Prolonged and/or high concentrations of oxygen may damage the pulmonary epithelium, and inactivate the surfactant, form intra-alveolar oedema and interstitial thickening, and later fibrosis, leading to pulmonary atelectasis → Tracheobronchitis,Acute respiratory distress syndrome (ARDS), and Pulmonany interstitial fibrosis. 3-Ocular effects: Reversible constriction of the peripheral field of vision, a progressive but reversible myopia, and delayed cataract formation , Temporarily blurred vision can be

caused by swelling of the lens, which usually resolves in two to four weeks. rare side effect has been blindness secondary to optic neuritis (inflammation of the optic nerve 4- Toxic effects on other tissues Abnormal RBC morphology with or without a reduction in circulating mass of RBCs with occasional episodes of haemolysis following HBOT have been observed.

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Serous otitis media and dysbaric osteonecrosis in astronauts have also been observed, which may be partially contributed to high oxygen concentrations during space flights II.COMPLICATIONS RATHER THAN OXYGEN TOXICITY: 1. CLAUSTROPHOPIA. 2-Pressure changes can cause a "squeeze" or barotrauma in the tissues surrounding trapped air inside the body, such as the lungs, behind the eardrum, inside paranasal sinuses, or trapped underneath dental fillings **OTOLOGICAL COMPLICATIONS.  Middle ear barotraumas is the most common adverse effect of HBO. As the ambient pressure within the chamber is increased to 2 atmospheres, a patient must be able to equalize the pressure within the middle ear by autoinsufflation. If a significant pressure gradient is allowed to develop, severe otalgia may occur, followed by haemorrhage or serous effusion. Additional reported complications of middle ear barotraumas include tympanic membrane perforation, ossicular chain disruption, or even oval or round window rupture, with resultant vertigo or sensorineural hearing loss  Instructing patients in proper autoinsufflation techniques during compression can minimize the risk of barotraumas during HBO. Adding oral and topical de-congestants to the regimen is indicated when nasal congestion compromises performance of autoinsufflation. Some patients continue to experience difficulty despite these measures, resulting in the need for myringotomy and tympanostomy tube insertion to allow continuation of HBO  To reduce the pressure, a valve is opened to allow air out of the chamber **SINUS SQUEEZE (BAROSINUSITIS). **DENTAL PROBLEMS.caused by the presence of an air space under a dental filling. 4. NUMB FINGERS. 5. GASTROINTESTINAL PAIN AND DISCOMFORt

Ozonetherapy OZONE IN NATURE  Ozone gas, is a molecule consisting of three atoms of oxygen in a dynamically unstable structure due to the presence of mesomeric states. The gas is colorless, acrid in odor and explosive in liquid or solid form.  In nature it is abundant only in the stratosphere it is produced by the action of ultraviolet solar radiation and in turn, protects the earth from ultraviolet solar radiation. Mechanisms of therapeutic action of ozone 12345-

bactericidal properties of ozone which is used today to sterilize water. Fish observed that ozone has topical therapeutic activity in various skin diseases Ozone has a vasodilator property on blood vessels. This property comes from the liberation of relaxing factor NO. ozone therapy enhances the generation of erythrocytes with improvement of metabolic characteristics, on the leucocytes it was suggested to have immunomodulatory effect. Ozone therapy is very useful in both acute and chronic bacterial, viral and fungal infections because the generated ROS are the natural and most effective agent to which even antibiotic resistant pathogens don’t resist

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METHODS of ADMINISTRATION:Traditional ozone therapies include; 1. Direct intra-arterial and intravenous application 2. Major and minor autohaemotherapy removing a small amount (usually 10 ml) of the patient’s blood from a vein with a hypodermic syringe. The blood is then treated with ozone and oxygen, and given back to the patient with an intramuscular injection. Thus the blood and ozone becomes a type of autovaccine given to the patient that is derived from their own cells(diving the patient own blood antiviral and antibacterial properties), These methods have been used to treat a wide variety of health problems, including herpes, arthritis, cancer, heart disease and HIV-infection.It is probably the most commonly used type of ozone therapy today

Figure 1 Autohemotherapy Kits (T.T.Tanbouli)

Major autohemotherapy

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3. Ozonated water ozone gas to be bubbled through water, and the water is used externally to bathe wounds, burns and slow-healing skin infections. It is also used as a disinfectant by dentists who perform dental surgery. used to treat a wide variety of intestinal and gynecological problems, including ulcerative colitis, duodenal ulcers, gastritis, diarrhea and vulvovaginitis 3. Intramuscular injection 4. Intra-articular injection: Acute and chronic inflammatory joint diseases improved with this treatment 5. Rectal and vaginal insufflations 6. Transdermal ozone gas sauna. 7. Limb bagging or booting. plastic bag that is placed around the area to be treated. An ozone/oxygen mixture is pumped into the bag and the mixture is absorbed into the body through the skin. Ozone bagging is primarily recommended for treating leg ulcers, gangrene, fungal infections, burns and slow-healing wounds

Figure 2 Rectal insufflations

Figure 3 limb bagging (Mawsouf et al., 2004) 9. Ozonated Olive Oil liniments & poultices. Used primarily to treat skin problems, ozone gas is added to olive oil and applied as a balm or salve for longterm, low-dose exposure INDICATIONS OF OZONE THERAPY: 1. HIV AND INFECTIOUS DISEASES 2. ISCHEMIA:Limb ischemia.CNS Ischemia Ischemic Heart Disease 3. OPHTHALMOLOG:retinitis pigmentosa myopia, chronic open angle glaucoma, optic atrophy and diabetic retinopathy 5. DENTISTRY 6. CANCER 7. SKIN CONDITIONS USES IN OTOLARYNGOLOGY – HEAD AND NECK SURGERY 1. HEAD & NECK TUMORS: Ozonetherapy has proved useful in the treatment of ischemic syndromes, and several studies have described a potential increase of oxygenation in tissues and tumors. Ozone therapy potentiates the action of chemotherapy as HBOT 2. IDIOPATHIC SENSORINEURAL HEARING LOSS (ISNHL)

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The application of ozone in treatment of ISNHL and idiopathic tinnitus may be helpful. That is due to the mechanism of action of medical ozone that can overcome the proposed etiological factors specially the most accepted hypothesis in ISNHL which are viral infection and vascular theory. The medical ozone considered a potent antibacterial and antiviral agent It was reported that ozone could increase the oxygenation of the ischemic tissues). Ozone as well exhibits immune modulatory effect INCOMPLETE COCHLEO VESTIBULAR SYNDROME A study done by Ernesto and others on 60 patients suffering from an incomplete cochleo vestibular syndrome with dizzy predominance, was performed. Patients were divided, at random, into four groups: 1-ozone, 2-acupuncture, 3-ozone plus acupuncture and 4-medications. A vascular examination with Doppler, of the basilar vertebra trunk, was made to each patient at the beginning, at the end of the different treatments and after 6 and 12 months. The results demonstrated a significant improvement in those patients treated with ozone and ozone plus acupuncture in comparison with group 2 and 4. No significant differences, between groups 1 and 3, were obtained. It is concluded that ozone therapy can be appropriate indication for this disease 5. MENIÈRE´S DISEASE A small series of patients with Menière´s disease were treated with inhaled ozone combined with pressure massage of the tympanic membrane. The outcomes for audiometric parameters showed no significant improvement although patients reported a subjective improvement of their symptoms after therapy 6. CHRONIC OTITIS MEDIA inflammation control of mucous membrane, discharge reduction and restoration of auditory tube function Fast antiinflammatory result of ozone therapy was due not only to its bactericidal effect but also via its antihypoxic and immunomodulating mechanisms 6. TEMPOROMANDIBULAR JOINT (TMJ) DISEASE -Under this heading are all disorders involving the TMJ and that can cause symptoms such as jaw clicking, inability to open the jaw fully and pain either in the jaw, teeth or face, etc. One case series of patients with different diseases involving the TMJ received intra-articular infiltration. The outcomes reported 1 month after treatment were as follows: pain symptoms disappeared entirely in 11 out of the 19 patients (57.9%) with menisco-condylar alterations; a clinical benefit was seen in 12 patients with osteoarthrosis and/or osteoarthritis while there was only limited benefit for the only patient with avascular osteonecrosis CONTRAINDICATIONS TO OZONE THERAPY All cases with Blood Coagulation Failure. 1) Bleeding Organs. 2) Thrombocytopenia. 3) Allergy to ozone has been claimed. But this is probable hypersensitivity of asthmatic patients when they were exposed to air polluted with ozone. 4) Hemorrhagic or Apoplectic Stroke. 5) Ozone Intolerance.

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6) Patients with a significant deficiency of G-6PD or Favism. RBCs have less of an ability to prevent hemolysis in the presence of ozone. 7) Pregnancy. 8) Patients on ACE inhibitors. 9) Abnormal situations with hyperthyroidism, thrombocytopenia and serious cardio-vascular instability. Toxicity and side effects of blood ozonationResearchers advocating ozone therapy concede that when infused into human blood, ozone produces reactive oxygen species (ROS) or free radicals, an overabundance of which is known to cause oxidative stress and cell damage, and is implicated in the progression of some degenerative diseases, however they argue that the body's anti-oxidant defense system is resistant to the quantities of ROS produced by the therapy. Interestingly, ROS have also been discovered to also perform an array of essential cell signaling functions Monitoring of ozone therapyIt is technically impossible to measure ozone directly in the blood or assay ROS in ozonated plasma because of their very brief half-life (fractions of a second. However, there are indirect methods of monitoring the oxidising action of ozone in the body through terminal products or biochemical modifications of the plasma antioxidant system

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Oxygen Therapy (Ozone therapy)

Introduction

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Oxygen Therapy (Ozone therapy)

Monitoring Of Ozone Therapy

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Monitoring Of Ozone

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