When a 58-year-old patient presented with sudden, complete loss of vision in both eyes and profound hearing impairment after ingesting a high dose of selenium, physicians faced a rare and potentially permanent neurological emergency. The case, reported in August 2026 in Frontiers in Pharmacology, illustrates both the devastating neurotoxic potential of selenium overdose and the critical role that hyperbaric oxygen therapy can play in multidisciplinary management of complex toxicological emergencies.
The Emergency Presentation
Selenium, an essential trace element in human nutrition, transforms into a potent neurotoxin when consumed in excessive quantities. The patient in this case report developed acute bilateral vision loss and sensorineural hearing deficits shortly after high-dose selenium ingestion—a presentation that reflects the element’s predilection for damaging highly metabolically active tissues, particularly the retina and cochlear structures.
The mechanism of selenium neurotoxicity involves oxidative stress, mitochondrial dysfunction, and disruption of cellular calcium homeostasis. Neural tissues, with their high metabolic demands and limited regenerative capacity, are especially vulnerable. Without prompt intervention, such damage often proves irreversible.
A Multidisciplinary Treatment Protocol
The clinical team implemented an aggressive, multi-pronged therapeutic strategy. The intervention included sedation to manage patient distress, diuretics to enhance elimination, corticosteroids to reduce inflammatory edema, organ protection protocols, neurotrophic support, and anti-infective prophylaxis. Central to this approach was the administration of hyperbaric oxygen therapy.
HBOT’s inclusion in the treatment regimen reflects its established physiological mechanisms: delivering oxygen at supra-atmospheric pressures increases dissolved oxygen in plasma, enhances tissue oxygenation beyond what hemoglobin can transport, reduces tissue edema, and mitigates oxidative stress in damaged neural tissues. For neuro-ophthalmological and neuro-otological emergencies involving ischemic or toxic insults, these properties make HBOT a theoretically appealing adjunctive therapy.
The FDA Context: Established Uses Versus Emergency Applications
While this case report documents HBOT’s use in a selenium toxicity emergency, it is important to understand where this application fits within regulatory frameworks. The FDA has cleared hyperbaric oxygen therapy for fourteen specific indications, including decompression sickness, carbon monoxide poisoning, certain non-healing diabetic wounds, and idiopathic sudden sensorineural hearing loss.
Notably, sensorineural hearing loss appears among FDA-cleared indications—a relevant parallel to the auditory symptoms in this selenium toxicity case. However, selenium-induced vision and hearing loss itself does not constitute an FDA-cleared indication. The therapy was administered as part of emergency toxicological management under physician judgment, not as an approved protocol.
The FDA has repeatedly emphasized that most wellness, longevity, and alternative uses of HBOT lack regulatory clearance. A 2025 safety letter to healthcare providers specifically warned about device-related fire risks, injuries, and deaths associated with hyperbaric chambers, underscoring the importance of treatment in accredited facilities with appropriate safety protocols.
Evidence Quality and Clinical Implications
This report represents a single case study—the lowest tier in the hierarchy of medical evidence. While the patient achieved recovery following the multidisciplinary protocol including HBOT, case reports cannot establish causality or demonstrate that any single intervention was responsible for the outcome. The natural history of selenium toxicity is variable, and spontaneous recovery cannot be excluded.
What the case does provide is a proof-of-concept and a therapeutic roadmap for future encounters with similar presentations. It documents that HBOT can be integrated safely into emergency toxicological management and suggests that the therapy may contribute to positive outcomes in neurotoxicological emergencies affecting sensory organs.
The Broader Landscape of HBOT in Toxicology
Carbon monoxide poisoning remains the primary toxicological indication for which HBOT holds FDA clearance. In CO toxicity, HBOT accelerates carboxyhemoglobin dissociation, provides oxygen independent of hemoglobin function, and reduces delayed neurological sequelae. The therapy’s role in other toxicological emergencies, including selenium, cyanide, and certain drug toxicities, remains investigational.
Research published in 2026 continues to explore HBOT’s potential applications in toxicology, stroke, traumatic brain injury, and neurodegenerative conditions. However, the gap between investigational applications and established, evidence-based indications remains substantial. The Cochrane Collaboration and other evidence-synthesis bodies have emphasized the need for randomized controlled trials to establish efficacy in these emerging areas.
Safety Considerations in Emergency HBOT
The 2025 FDA safety communication regarding hyperbaric devices serves as a critical backdrop for any discussion of HBOT implementation. The letter documented injuries, deaths, and fire incidents associated with hyperbaric oxygen therapy, particularly when devices are used improperly or outside accredited facilities.
For emergency applications like the selenium toxicity case described, treatment in a hospital-based, UHMS-accredited facility with comprehensive monitoring capabilities becomes essential. The risks of oxygen toxicity, barotrauma, and fire must be balanced against potential benefits in life- or sense-threatening emergencies.
Looking Forward
This case report contributes to the growing literature on HBOT applications in neuro-ophthalmological and neuro-otological emergencies. While it does not establish a new standard of care, it provides clinicians with a documented example of successful integration of HBOT into complex toxicological management.
For patients and practitioners alike, the case underscores the importance of selenium safety—this essential trace element becomes dangerous at doses not far exceeding nutritional requirements. It also highlights the evolving role of hyperbaric medicine in addressing complex medical emergencies where traditional therapeutic approaches may be insufficient.
As research continues, the boundaries of FDA-cleared HBOT indications may expand, but until rigorous clinical trials provide definitive evidence, applications like selenium toxicity management remain in the realm of informed clinical judgment rather than established protocol. The balance between innovation and evidence remains the central tension in hyperbaric medicine’s ongoing evolution.