Acute epiglottitis in adults

Epiglottitis occurs more frequently in adults than is generally realized. More than 100 adults with epiglottitis have been reported prior to this paper. Sixty-two have been reported in the last 15 years. The mortality rate of these 62 patients was 32 percent. Tracheostomy was required in 45 percent of those who recovered. Seventeen adults with epiglottitis have been managed at the Los Angeles County/University of Southern California Medical Center in the past 10 years; 13 of these were seen in the last four years. Most were males between 20 and 45 years of age. Four required tracheostomy. There were no deaths. An additional adult, treated at a neighboring hospital, who recovered from Hemophilus influenzae epiglottitis and meningitis is reported. He required tracheostomy for acute airway obstruction. The following impressions can be derived from an anlysis of the literature and the patients discussed in this paper: 1. epiglottitis in adults has been reported more often in recent years. This may be due to increased awareness of this condition; or it may be due to actual increased incidence. 2. Epiglottis is more severe when due to Hemophilus influenzae, Type B than when due to other pathogens; and infections due to H. influenzae are being noted more frequently in adults. 3. The primary treatment of adult epiglottitis is: mist tent, intravenous antibiotics, and tracheostomy when indicated. Steroids may benefit some patients by slowing progression of epiglottic edema. 4. The symptoms of epiglottitis are sore throat, dysphagia, respiratory distress, and muffled voice. The characteristic early symptoms are sore throat and dysphagia. Any patient with acute painful dysphagia should have indirect laryngoscopy to rule out epiglottitis.     

Acute epiglottitis in adults: bacteriology and therapeutic principles

Acute epiglottitis is seldom encountered in adults, but the condition is probably more frequent than reported in the literature. Nineteen cases of adult epiglottitis were analysed retrospectively. In 53% of the patients, the symptoms were present for less than 24 h prior to hospitalization. Sore throat and dysphagia were invariably present. Three patients presented with stridor and 2 with complete airway obstruction. Throat cultures from 5 patients grew beta-haemolytic streptococci and from 2 Haemophilus influenzae type B was grown. Two tracheotomies and 1 nasotracheal intubation were performed. One death occurred. It is emphasized that any adult with an acute sore throat and dysphagia should undergo indirect laryngoscopy and that blood cultures should always be part of the routine bacteriological investigation. Cooperation and understanding among otolaryngologists and anaesthesiologists is of paramount importance in the management of acute adult epiglottitis, as nasotracheal intubation and cricothyroidotomy appear to be the methods of choice in securing an airway. Ampicillin and chloramphenicol are recommended in the medical treatment.     

Acute epiglottitis in adults: Experience with fifteen cases

Fifteen adults with acute epiglottitis are discussed. Three required tracheostomy because of delayed diagnosis. There were no deaths. Epiglottitis occurs more often in adults than is generally recognized. The early symptoms of epiglottitis in adults are sore throat and dysphagia. Any patient with acute, painful dysphagia should have indirect laryngoscopy to rule out epiglottitis. Throat and blood cultures were obtained from 14 of our cases. Cultures from only two patients were positive for Hemophilus influenzae, type B; cultures from the other 12 patients did not grow any bacterial pathogens. The primary treatment of adult epiglottitis is intravenous steroids, antibiotics, and humidified oxygen. Observation by the managing physician is mandatory during the first four hours of treatment. Tracheostomy is indicated in progressive disease.     

成人急性会厌炎67例报告

为对成为急性会厌炎有进一步的了解。报告６７例本病患者的临床资料。６７例有咽痛，５３例有吞咽困难。会厌舌面粘膜均有不同程度的充血水肿，致使气道阻塞，出现呼吸困难。，认为治疗成人急性会厌炎的重点是抗感染和维护呼吸道通畅，必要时建立人工气道；对于并发会厌脓肿者应酌性切开排脓。     

Acute epiglottitis in children: experiences with tracheotomy and intubation

Acute epiglottitis is one of the most serious and potentially fatal conditions dealt with in paediatric laryngology. The infectious agent is mostly Haemophilus influenzae. An active and planned treatment to secure the airway is necessary to reduce the morbidity and mortality. The ‘watch and wait’ attitude should be abandoned. Tracheotomy or intubation should be performed. Mostly literature today is in favour of intubation. However, both tracheotomy and intubation can be used, and if properly managed the complication rate with both methods is low. This series comprised 102 children of whom 79 were tracheotomized and 23 were intubated. No differences could be found between intubation or tracheotomy time (2.3 and 2.9 days respectively) or in hospital stay (6.7 and 6 days). The complication rate was low in both groups except for subcutaneous and mediastinal emphysema in the tracheotomy group but these did not cause any serious problems.     

Acute epiglottitis in adults: a recent experience with 10 cases

OBJECTIVES: Our objective was to examine the presentation, clinical course and management of acute epiglottitis in a recent series of adult patients. METHOD: All consecutive adults with acute epiglottitis or supraglottitis admitted to a tertiary referral centre over a recent six-month period were included in this retrospective study. The diagnosis of epiglottitis or supraglottitis was established by flexible nasolaryngoscopy. RESULTS: Ten patients were included. Two patients had concurrent acute tonsillitis and one had a peritonsillar abscess. Blood cultures were negative in all cases. Pathogens were isolated by throat swabs only in the two patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of cefotaxime and metronidazole was the most common antibiotic regimen used. CONCLUSION: The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.     

Acute epiglottitis in adults (the Singapore experience)

Acute epiglottitis in adults is a potentially fatal but self-limiting disease of increasing incidence world-wide. Forty-two patients, seen consecutively over a four year period at the ENT Department, Singapore General Hospital were reviewed retrospectively. A strong male predominance with a peak age incidence in the sixth decade was noted. A severe sore throat and dysphagia with disproportionate signs of oropharyngeal inflammation was the main presenting picture. Only three patients had stridor on presentation. Vigilant monitoring of the airway with empirical high-dose intravenous ampicillin, cloxacillin and steroids resulted in a dramatic clinical improvement in most patients and none developed stridor after admission. The yield from throat swabs and blood cultures were low. Two patients developed complications, a Ludwigs angina and an epiglottic abscess. Recurrent epiglottitis was a problem in one patient. There was low morbidity and no mortality on the management regime outlined.     

Acute epiglottitis in adults. Our case load in 11 years

We report a retrospective study of 20 cases of acute epiglottitis in adults admitted at our hospital between 1991 and 2001. We gather a series of variables: Patient sex, age, year and month of admission, personal history, initial clinical symptoms, complementary tests asked, given treatment, evolution and hospital average stay. We found an obvious predominance in male (19:1 with respect to female), with an average age of 45 years. The main symptoms were dysphagia-odynophagia (85%), followed by fever (55%) and pharyngocervical pain. Dyspnea was confirmed in 9 of 20 patients (45%); 5 of them required airway control with the help of intubation in one case, urgent coniotomy in three cases and tracheotomy in another one. A patient suffered from an acute mediastinitis and required assistance and medical i.v. extended treatment in UCI. We show a case of another patient who suffered sudden cardiorespiratory arrest a followed by death. He did not present previous dyspnea. Acute epiglottitis in adults is a rare pathology with a good prognosis in general, but may lead to an unpredictable and serious complication even in the absence of airway blockage. We carry out a medical literature review in this respect.     

The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis

Clin. Otolaryngol. 2010, 35 , 18–24. Objective: To evaluate the effects of a coexisting epiglottic cyst on the clinical course and airway management of acute epiglottitis in adults. A review of the airway risk factors were studied in adults with acute epiglottitis in South Korea from 1997 to 2009. Design: Retrospective chart review. Setting: Academic tertiary care referral medical center. Participants: The study included 117 adult patients that were diagnosed with acute epiglottitis laryngoscopically over a period of 12 years. Two distinct groups were identified: one with acute epiglottitis associated with an infected epiglottic cyst (n = 29, 25%) and the other with acute epiglotittis without a cyst (n = 88, 75%). Main outcome measures: Patient background data, clinical manifestations, laboratory data, airway management, outcomes, and recurrence were recorded. Results: Eight (28%) out of 29 patients with an infected epiglottic cyst required airway intervention compared to the four (5%) out of 88 patients without a cyst. The difference between the two groups was statistically significant (P = 0.001). Five out of six patients with recurrent acute epiglottitis had a coexisting epiglottic cyst. The recurrence of acute epiglottitis in patients with a cyst was significantly more frequent (P = 0.003). Twelve patients (10%) required airway intervention. There was no mortality found in this study. Logistic regression analysis showed that an older age, dyspnoea, a high pulse rate, and the presence of an epiglottic cyst were associated with an increased risk for airway obstruction. Conclusions: The results of this study showed that a pre-existing epiglottic cyst might be associated with a suppurative infection of the supraglottis. Infected epiglottic cysts increased the risk for airway obstruction and recurrence of acute epiglottitis.     

Acute epiglottitis: decade of change--a 10-year experience with 242 children

Acute epiglottitis is a life threatening infection of the supraglottic structures. It more commonly occurs in early childhood but affects all age groups. Haemophilus influenzae type B is the usual pathogenic organism. The disease may progress so rapidly that sudden upper airway obstruction will occur, resulting in hypoxic brain damage or death. A retrospective study was completed on all patients (242) admitted to the Hospital for Sick Children in Toronto with a diagnosis of acute epiglottitis from January 1976 to December 1985. Prior to 1976, tracheotomy was the more common form of airway control but during the 10-year period reviewed endotracheal intubation was utilized almost universally in the 85% of patients having airway control and was associated with equally low morbidity. Airway obstruction prior to admission to the Hospital for Sick Children resulted in the subsequent deaths of five patients and persistent neurological deficits in four other surviving patients. The emergence of resistant strains of Haemophilus B organisms has altered antimicrobial management.     

Acute epiglottitis: intubation versus tracheostomy

Acute epiglottitis is a disease with significant mortality. The patient, usually an otherwise healthy pre-school child, develops a sore throat and muffled voice from swollen supraglottic structures, and may progress rapidly to respiratory arrest. Early diagnosis and airway maintenance can prevent these fatalities. Whether to secure an airway by tracheostomy or endotracheal intubation is the subject of much discussion. Nineteen series totalling 738 cases of epiglottitis plus 11 new cases are reviewed. These patients were treated as follows: Tracheostomy = 348 (3 deaths - 0.86%); Endotracheal intubation = 216 (2 deaths - 0.92%); medical management with no artificial airway = 214 (13 deaths - 6.1%). The difference in morbidity and mortality between tracheostomy or nasotracheal intubation is so slight that the choice should be determined by local factors. Medical management with no artificial airway should not be used in children.     

Acute epiglottitis in the adult

Acute epiglottitis may be fatal when diagnosis is delayed. The literature stresses data that does not help to predict impending airway obstruction in patients who present with a sore throat, the most consistent presenting symptom among patients with acute epiglottitis. In this review of 80 cases of epiglottitis in adults, almost all patients who presented within eight hours from onset of symptoms required airway intervention, while the majority of those who presented more than eight hours after onset of symptoms never developed acute upper respiratory obstruction and were treated medically or had supportive treatment only. Artificial airway was indicated in all patients who had drooling. There were no fatalities in this series, however, we recommend keeping all patients with acute epiglottitis in an intensive care unit for at least 24 hours after admission.     

Acute epiglottitis in children - the morbidity of management by elective tracheostomy

Acute epiglottitis is a pediatric airway emergency. No deaths occurred in 61 cases treated by elective tracheostomy at The Montreal Children's Hospital between 1966 and 1974. Seven patients (11.5%) showed evidence of aspiration pneumonia prior to tracheostomy and seven others developed pulmonary atelectasis in the first 24 hours following tracheostomy but only 9.8% of the total had a complication which continued in evidence 24 hours following surgery. A further 19.5% developed further complications unrelated to this earlier morbidity prior to discharge from hospital. The mean cannulation time was seven days and the mean hospital stay was nine days. Of these patients, 32 (52.4%) were seen between a year and seven-and-a-half years later. Twenty were completely asymptomatic with a small, neat scar. Twelve patients had experienced some upper respiratory problem or minor problems related to the tracheostomy incision.