Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

Osteomyelitis
The study by Esterhai et al 58 was a comparative study published in 1987. The study was
conducted in the United States and examined 28 consecutive patients (19 males), aged 15
to 74 years (mean = 40), with chronic refractory osteomyelitis uncomplicated by
persistent fracture non-union, septic arthritis, total joint arthroplasty or major systemic
disease.
The comparison group underwent debridement, and antibiotics were given based on the
results of microbial sensitivity. Fourteen subjects were exposed to HBO at 2 ATA for
2 hours daily, six days a week.
Exposure to HBOT did not produce a statistically significant improvement over the
comparison therapy in length of hospitalisation, clinical outcome, or recurrence
(Table 30).
Table 30 Outcomes in intervention and comparison groups with osteomyelitis (Esterhai et al). 58 *
Outcome Intervention Group
(n=14)
Mean length of hospitalisation (days)
54
(41-143) †
Comparison Group
(n=14)
47
(10-66) †
Treatment success (n) 11 13 0.2801
Recurrences ‡ (n) 2 1 0.5412
* Abbreviations: n = sample size.
† Figures in parentheses are ranges.
‡ Follow-up ranged from 11 to 77 months (mean = 41.1).
Summary
The regime of HBOT reported in this study does not seem to be beneficial to patients
diagnosed with osteomyelitis in terms of their length of hospital stay, the treatment
successes, and the risk of recurrence following therapy. However we should note that
this regime differs in several respects to HBOT regimes used for other indications,
calling into question the extent to which findings may be generalisable.
Osteoradionecrosis
Two aspects of the control of this condition are examined: prevention and treatment.
Prevention
Marx et al59 published a study in 1985 describing the results of a randomised controlled
trial conducted in the United States. The trial involved 74 patients (ages and genders not
specified) who had an indication for removal of one or more teeth in a segment of the
mandible which had received a documented absorbed dose of 6,000 rads or greater, and
who agreed to maintain follow-up visits for a minimum of six months. Excluded were
patients who received irradiation less than six months or more than 15 years prior to
enrolment, had known contraindications to penicillin or exposure to 100% oxygen at 2.4
ATA, showed evidence of persistent tumour or new primary malignant disease, received
chemotherapy within six months of enrolment, including steroid drugs, or had
concomitant systemic disease which could be expected to affect wound healing.
Hyperbaric oxygen therapy 39
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