EBOO vs 10-Pass Ozone Therapy: Differences, Costs, and Which Is Better

EBOO and 10-Pass ozone are the two most advanced systemic ozone therapies available, and they are frequently confused with each other despite working through fundamentally different mechanisms. EBOO (Extracorporeal Blood Oxygenation and Ozonation) filters blood outside the body through an ozone-infused dialysis-like circuit. 10-Pass (also called Multi-Pass or Hyperbaric Ozone) draws blood, ozonates it under pressure, and reinfuses it, repeating this cycle 10 times in a single session. Both deliver significantly more ozone than standard Major Autohemotherapy (MAH), but they do so in different ways and are suited to different clinical situations.

This guide provides a head-to-head comparison of EBOO and 10-Pass ozone therapy, covering mechanisms, session experience, costs, evidence quality, and which conditions each approach is best suited for.

How EBOO Works

EBOO stands for Extracorporeal Blood Oxygenation and Ozonation. Think of it as a simplified dialysis-like procedure that adds ozone exposure to blood filtration.

The process:

1. Blood is drawn from one arm via IV access
2. It passes through an external circuit containing a specialized filter membrane
3. Ozone/oxygen gas is introduced on one side of the membrane while blood flows on the other
4. The membrane allows gas exchange: ozone contacts the blood while also filtering out certain waste products, fats, and inflammatory mediators
5. The ozonated and filtered blood returns to the patient through the other arm

The dual action is what distinguishes EBOO from other ozone methods. It is not just ozone therapy. It is ozone therapy plus a filtration/detoxification step. Proponents argue this makes it particularly effective for conditions involving toxic burden, chronic infections, and metabolic dysfunction.²

You can see the filtration effect in real time: the blood going into the circuit appears dark, and the blood returning appears significantly brighter red (indicating improved oxygenation). The filter often collects visible yellow/brown waste material. While this visual effect is dramatic, it should be interpreted cautiously. Changes in blood color primarily reflect oxygenation status, and the filtered material has not been rigorously analyzed in published studies.

How 10-Pass Ozone Works

10-Pass ozone therapy, developed by Dr. Johann Lahodny in Austria, uses a specialized device (the Zotzmann Ozon 2000) that draws blood into a vacuum bottle, exposes it to ozone under positive pressure (0.8 to 1.0 bar), and reinfuses it. This cycle is repeated 10 times in a single session.¹

The process:

1. Approximately 200 mL of blood is drawn into a glass vacuum bottle
2. Ozone is introduced under pressure, forcing more ozone into solution than atmospheric-pressure methods allow
3. The ozonated blood is reinfused via gravity or mild pressure
4. Steps 1-3 are repeated 9 more times

The key innovation is the hyperbaric ozone exposure. Henry’s Law dictates that gas solubility in liquid increases with pressure. By ozonating blood under pressure, 10-Pass dissolves significantly more ozone per volume of blood than standard MAH. Across 10 passes, the total ozone dose delivered is roughly 10 times what a single MAH session provides.³

For more detail on 10-Pass, see our full guide: 10-Pass Ozone Therapy. For more on EBOO, see: EBOO Ozone Therapy.

“EBOO adds a filtration component that 10-Pass does not have. 10-Pass delivers a higher total ozone dose under pressure. They are complementary technologies, not competing ones.”
Clinical observation from integrative medicine practitioners

Head-to-Head Comparison

Which Conditions Favor Which Approach?

Can You Do Both?

Yes. Some practitioners offer combined EBOO + 10-Pass protocols, typically scheduling them on different days within the same week. The rationale is that 10-Pass delivers maximum ozone dose while EBOO provides the filtration/detoxification component. Together, they address both the “treat” and “clean” aspects of systemic therapy.

Common combination protocols:

• Alternating: 10-Pass on Monday, EBOO on Thursday, for 4 to 6 weeks
• Sequential: EBOO first (filter blood), then 10-Pass 24 to 48 hours later (maximize ozone on cleaner blood)
• Front-loaded: Start with 3 to 4 EBOO sessions to detoxify, then switch to 10-Pass for maintenance

Combination protocols are expensive ($1,600 to $3,500 per week) and are typically reserved for complex, treatment-resistant cases like chronic Lyme disease, mold illness, or Long COVID.

Evidence Quality: An Honest Assessment

Neither EBOO nor 10-Pass has strong clinical evidence. Here is a frank assessment of where the evidence stands for each:

10-Pass Evidence

• More published case series and clinical observations
• Dr. Lahodny and collaborators have published protocol descriptions and outcome data
• Used in European clinics for over a decade with documented safety
• No large RCTs

EBOO Evidence

• Very few published studies specific to the EBOO procedure
• Draws theoretical support from both ozone therapy literature and dialysis/apheresis literature
• Growing adoption in US integrative medicine clinics but limited published outcomes
• No RCTs

Both therapies exist in the same evidence tier: mechanistically plausible, supported by clinical experience, but unproven by the standards of conventional evidence-based medicine. Patients choosing either approach should understand they are opting for an experimental treatment.

Cost Comparison

Neither is covered by health insurance in the United States.

Safety

Both procedures require trained medical professionals and proper equipment:

• EBOO risks: Air embolism (if equipment malfunctions), hemolysis (if filter is damaged), infection (two IV sites), hypotension, hematoma at IV sites
• 10-Pass risks: Hemolysis (if ozone concentration too high), air embolism (rare with proper equipment), vasovagal reaction, bruising at IV site
• Shared contraindications: G6PD deficiency, active bleeding disorders, pregnancy, severe anemia

Both procedures are generally well tolerated by trained providers using properly maintained equipment. EBOO carries slightly more risk due to the complexity of the extracorporeal circuit and the need for two IV access points.

The Bottom Line

EBOO and 10-Pass are different tools for different jobs. 10-Pass is the better choice when the primary goal is maximum ozone delivery for conditions like chronic infections, immune modulation, or general optimization. EBOO is the better choice when blood filtration and detoxification are priorities, such as mold illness, toxic burden, or metabolic conditions.

For complex, multi-system conditions (chronic Lyme, Long COVID, CIRS), combining both approaches may offer the most comprehensive treatment, though at significant cost and without strong evidence to guide optimal protocols. Both remain experimental, and patients should make decisions based on their specific clinical situation, provider experience, and financial capacity.

References

1. Lahodny J. “High-dose ozone therapy (OHT): Ten-pass ozone as a therapeutic method.” Zeitschrift fur Ganzheitliche Tiermedizin. 2014;28:45-50.
2. Di Mauro R, et al. “EBOO therapy: a new approach in ozone treatment.” Journal of Ozone Therapy. 2019;3(4):1-6.
3. Bocci V. “Ozone: A New Medical Drug.” 2nd ed. Springer; 2011.
4. Smith NL, et al. “Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility.” Medical Gas Research. 2017;7(3):212-219. doi:10.4103/2045-9912.215752
5. Elvis AM, Ekta JS. “Ozone therapy: a clinical review.” Journal of Natural Science, Biology and Medicine. 2011;2(1):66-70. doi:10.4103/0976-9668.82319
6. Sagai M, Bocci V. “Mechanisms of action involved in ozone therapy.” Medical Gas Research. 2011;1(1):29. doi:10.1186/2045-9912-1-29
7. Bocci V, et al. “The ozone paradox: ozone is a strong oxidant as well as a medical drug.” Medicinal Research Reviews. 2009;29(4):646-682. doi:10.1002/med.20150