ENHyperbaric oxygen therapy (HBOT) in Germany is a treatment in which the patient breathes pure oxygen in a pressure chamber at a pressure higher than normal air pressure, so much more oxygen dissolves in the blood and reaches damaged tissue.
This page is for patients with non-healing wounds, late effects of radiotherapy, carbon monoxide poisoning or a diving accident, and for families who have seen HBOT advertised for other conditions. It covers how HBOT works, when it is used and when evidence is lacking, what a session involves, its risks and how treatment is arranged.
How oxygen under pressure works
Under pressure, oxygen dissolves directly in the plasma, the liquid part of the blood, so far more of it reaches tissue with a poor blood supply. This supports wound healing and the growth of new small blood vessels, reduces swelling and helps against bacteria that cannot live with oxygen, such as those causing gas gangrene. Pressure also shrinks gas bubbles, which is why HBOT helps in decompression illness, where bubbles form in a diver’s body after surfacing.
Still, more oxygen is not always better. Oxygen under pressure acts like a medicine, with a dose, side effects and contraindications, and too much of it does harm. HBOT is therefore a medical treatment with defined indications, prescribed and supervised by a doctor.
When hyperbaric oxygen therapy is used
HBOT is used for indications recognised by the German Society for Diving and Hyperbaric Medicine (GTÜM): urgently in emergencies, and as planned treatment when a wound or radiation injury fails to heal with standard care. Emergencies include decompression illness after diving, arterial gas embolism (gas bubbles blocking blood vessels), carbon monoxide poisoning, gas gangrene and some severe soft tissue infections, treated at chambers with round-the-clock readiness and intensive care.
Planned treatment covers diabetic foot ulcers that do not heal with standard wound care, radiation damage to bone and soft tissue after radiotherapy, for example of the jaw, and some other problem wounds. A Cochrane review found that HBOT helped these ulcers heal in the short term but not the long term, and the trials had various flaws. In Germany, statutory health insurance covers HBOT for diabetic foot syndrome if the ulcer has reached the tendons or joint capsule and has not healed despite guideline-based wound care at a specialised facility. See also diabetes treatment in Germany and the cost of radiotherapy.
Other uses are contested. For sudden hearing loss, the European list of indications published by GTÜM recommends HBOT together with medication if it is started early, but a Cochrane review on hearing loss found the clinical significance of the benefit unclear. For tinnitus and autism the same list advises against HBOT, for long COVID it is still being studied, and for «anti-ageing» there is no confirmed evidence. We do not recommend HBOT for tinnitus, autism, long COVID or «anti-ageing».
What a session in a pressure chamber is like
A session takes place in a pressure chamber under the eye of trained staff, after an examination: the doctor checks the ears, lungs and heart, orders a chest X-ray or other tests if needed and reviews the patient’s medicines.
Germany mostly uses multi-place chambers: patients sit side by side and breathe oxygen through a mask or hood, with a trained attendant or doctor in the chamber or watching by video and intercom. As the pressure slowly rises, the ears need equalising, as in a descending aeroplane; then comes a phase of breathing oxygen, followed by slow decompression. The doctor sets the number and length of sessions.
Treatment courses for wounds usually involve a series of sessions on consecutive days, so patients from abroad need accommodation near the centre for the whole course. Wound care continues alongside.
Risks and who should not have HBOT
Most patients tolerate HBOT well; common side effects are usually harmless: pressure in the ears and sinuses, temporary short-sightedness that usually resolves after the course, and fatigue. If the ears cannot equalise, ear barotrauma, a pressure injury of the middle ear, can occur; it is one of the most common side effects and is usually minor. Lung barotrauma and oxygen-related seizures are rare, and some people find the closed chamber frightening.
The main absolute contraindication is an untreated pneumothorax, meaning air between the lung and the chest wall. Caution is needed with some medicines, such as certain chemotherapy drugs, with acute colds and with certain lung diseases; the hyperbaric physician decides whether HBOT is possible. A second opinion from the patient’s own specialist, such as a diabetologist or radiotherapist, belongs in the plan.
Frequently asked questions
Is hyperbaric oxygen therapy safe?
Broadly yes, when it is given for a recognised indication, after an examination and under supervision: serious complications are rare. Pressure in the ears is the most common complaint, and mild ear barotrauma or temporary short-sightedness can occur. Tell the staff about a cold, ear pain or new medicines before a session.
How many HBOT sessions will I need?
The hyperbaric physician decides after the examination; nobody can give a number in advance. It depends on the condition, how the patient tolerates treatment and how the wound responds. Wounds and radiation injuries usually need a series of sessions on consecutive days, reviewed along the way, so travel dates are agreed with the centre beforehand.
How is medical HBOT different from wellness oxygen chambers?
Medical HBOT is prescribed for recognised indications and given in a medical chamber after an examination and under a doctor’s supervision. Wellness sessions promising energy or «rejuvenation» are not backed by confirmed research; the European Committee for Hyperbaric Medicine and the European Underwater and Baromedical Society advise against using chambers for such unconfirmed effects.
How AlenMed arranges hyperbaric oxygen therapy in Germany
AlenMed prepares the documents, contacts pressure chamber centres and organises the trip. We collect the diagnosis, photos and a description of the wound, previous treatment, diabetes and circulation findings, for example from diabetes diagnostics, and radiotherapy reports, and have them translated. In a video consultation, a doctor assesses whether HBOT makes sense at all.
We then contact pressure chamber centres run by or linked to hospitals. The hyperbaric physician confirms the indication, the centre issues a cost estimate (Kostenvoranschlag), and after the deposit the visa invitation follows; we arrange accommodation near the centre and an interpreter (see arranging treatment in Germany). The AlenMed office is in Munich; partner hospitals are across Germany.
This material is for reference only and is not an offer. Whether HBOT is appropriate is decided by the doctor after an in-person examination.