Hyperbaric chambers can cause ear pressure and temporary discomfort, but permanent hearing loss from HBOT is not documented in large clinical studies. The most common ear issue is middle ear barotrauma, a pressure equalization problem that affects 9–15% of patients. Most cases are mild and self-resolving. This guide covers what research shows, who is at higher risk, and how to protect your ears during HBOT.
What Is Middle Ear Barotrauma?
Middle ear barotrauma (MEB) occurs when the air pressure outside your eardrum rises faster than the air pressure inside the middle ear can equalize through the Eustachian tube. This is exactly the sensation you feel on an airplane during descent, amplified by the faster and greater pressure changes of a hyperbaric session.
During compression, if you cannot equalize the pressure difference, it creates pain, a feeling of fullness, and occasionally temporary muffled hearing. In mild cases, the discomfort resolves once the chamber reaches operating pressure and no further changes occur. In more severe cases, fluid may accumulate behind the eardrum or the eardrum may be damaged.
The condition is classified using the Teed Ear Drum (TEED) scale from Grade 0 (no injury) to Grade 5 (tympanic membrane perforation). In Heyboer et al.’s study of 236 patients, 84% of MEB cases were Grade 1–2 (minor, no medical intervention required).[6]
Who Is at Higher Risk of Ear Problems During HBOT?
Multiple large studies have identified consistent risk factors:[1]
- Female sex: Consistently identified across multiple studies (Voigt 2025, Hadanny 2016, Nasole 2019)
- Age over 55: Eustachian tube function decreases with age
- Head and neck pathology: Cancer, previous radiotherapy to the head and neck region
- Upper respiratory infection: Active congestion impairs Eustachian tube function
- Sensory neuropathy: Inability to feel ear pain means inability to report inability to equalize
- Prior difficulty equalizing: Self-reported pre-treatment difficulty is the most practical predictor
- Thyroid disorders, obesity, obstructive breathing disorders
Protective factors: Experience with effective equalization techniques, slow compression rate, thorough pre-treatment training, and in-chamber health professional attendance (in multiplace chambers).[1]
HBOT for Hearing Loss: A Legitimate Treatment
While HBOT can cause temporary ear issues, it is also an established treatment for a specific type of hearing loss. Sudden sensorineural hearing loss (SSNHL) responds to HBOT when treatment begins within days of onset.
Multiple studies support HBOT adjunctive to steroid therapy for SSNHL, with protocols of 10–20 sessions at 2.0–2.5 ATA. Results are time-sensitive: the best outcomes occur when treatment begins within the first 7–14 days of hearing loss onset.[7] The FDA has cleared HBOT for idiopathic sudden sensorineural hearing loss as one of its 14 approved indications.
How to Protect Your Ears During HBOT
- Learn equalization techniques before your first session. Practice the Valsalva maneuver (pinch your nose and blow gently), yawning, and swallowing. Ask your provider to demonstrate these before you start.
- Report ear pain immediately during compression. Alert the technician if you cannot equalize. Stopping compression briefly prevents a mild issue from becoming significant barotrauma.
- Do not go into HBOT with a respiratory infection. Congestion impairs Eustachian tube function and dramatically increases barotrauma risk. Reschedule if you are unwell.
- Slow compression helps. Ask your provider about their compression rate protocol. Staged compression reduces severity of barotrauma even if it does not reduce overall incidence.[8]
- Discuss pre-existing ear conditions with your provider. Previous ear surgery, chronic ear infections, or auditory conditions require evaluation before starting HBOT.
Frequently Asked Questions
Will HBOT damage my hearing permanently?
Large studies including 18,284 patients have not documented permanent sensorineural hearing loss as a consequence of standard HBOT. Middle ear barotrauma is a pressure equalization issue that primarily affects the middle ear, not the inner ear or auditory nerve where permanent hearing damage occurs.[1]
My ears always hurt on airplanes. Will HBOT be worse?
Potentially, yes. Difficulty equalizing ear pressure on airplanes is a predictor of higher barotrauma risk during HBOT. Discuss this with your provider before starting. Slow compression rates and practiced equalization techniques significantly reduce risk, and in some cases ear specialists recommend myringotomy tubes for patients who cannot equalize reliably.
Can I do HBOT if I have a perforated eardrum?
This requires physician evaluation. A perforated eardrum actually equalizes pressure differently than an intact one. Some providers clear patients with healed perforations; active perforations require careful assessment. Do not start HBOT without disclosing any ear surgery or known ear condition.
References
- Voigt A, Laspro M, Thys E, Jethanamest D, Chiu ES. Systematic Review of Otologic Adverse Events in HBOT. Undersea & Hyperbaric Medicine. 2025. DOI: 10.22462/736 PMID: 41429031
- Beuerlein M, Nelson R, Welling DB. Inner and Middle Ear Hyperbaric Oxygen-Induced Barotrauma. The Laryngoscope. 1997;107(10):1350-1356. DOI: 10.1097/00005537-199710000-00011 PMID: 9331312
- Nasole E, Zanon V, Marcolin P, Bosco G. Middle ear barotrauma during HBOT; a review of 5,962 patients. Undersea & Hyperbaric Medicine. 2019;46(2):207-216. DOI: 10.22462/04.06.2019.2 PMID: 31051054
- Mirasoglu B, Cakkalkurt A, Cimsit M. Complication of HBOT: symptomatic middle ear and cranial sinus barotrauma. 2017. DOI: 10.18017/IUITFD.308489
- Plafki C, Peters P, Almeling M, et al. Complications and side effects of hyperbaric oxygen therapy. Aviation, Space, and Environmental Medicine. 2000;71(2):119-124. PMID: 10685584
- Heyboer M, Wojcik S, Grant W, et al. Middle ear barotrauma in HBOT. Undersea & Hyperbaric Medicine. 2014;41(5):393-397. PMID: 25558548
- Kim H, et al. Optimized Protocol of HBOT for Sudden Sensorineural Hearing Loss. The Laryngoscope. 2022;132(10):2045-2052. DOI: 10.1002/lary.30181 PMID: 35548932
- Ng A, Muller R, Orton J. Incidence of MEB in staged vs linear chamber compression during HBOT. Undersea & Hyperbaric Medicine. 2017;44(2):121-128. DOI: 10.22462/3.4.2017.3 PMID: 28777900
Medical Disclaimer
The content on BaricBoost.com is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Author
Seph Fontane Pennock is the founder of BaricBoost.com and Regenerated.com, a clinic directory for regenerative medicine serving 10,000+ providers across the United States. He previously built and sold PositivePsychology.com, which grew to 19 million users and became the largest evidence-based positive psychology resource on the web. Seph brings direct experience as an HBOT patient, having completed protocols at clinics across three continents while navigating mold illness, systemic inflammation, and autoimmune conditions. His treatment journey includes hyperbaric oxygen therapy, peptide protocols, NAD+ therapy, and consultations with specialists from Dubai to Cape Town to Mexico. This combination of entrepreneurial track record and lived patient experience shapes everything published on BaricBoost.com. Every article is grounded in peer-reviewed research, informed by real clinical encounters, and written for patients making high-stakes treatment decisions. Seph's focus is on bringing transparency, scientific rigor, and practical guidance to the hyperbaric oxygen therapy space.
