Adult epiglottitis

Epiglottitis is supraglottic inflammation of the oropharynx caused by infective, thermal, or caustic insult. Rapid swelling of the epiglottis results in airway obstruction and asphyxia. Widespread use of HiB vaccination in children has resulted in a reduction in childhood cases of epiglottitis. The majority of adults have not received vaccination, and remain susceptible. Peak incidence is in the 35- to 39-year-old age group with an annual incidence of 0.97-1.8/100,000, approximately 2.5 times the incidence in children (Sack and Brock, 2002; Carey, 1996; Fontanarosa et al., 1989). We present three cases of adult epiglottitis presenting to a District Hospital Accident and Emergency (A&E) department in Yorkshire over a six-month period.     

Adult respiratory distress syndrome in a child with acute epiglottitis

Intubation of a 23-month-old child suffering epiglottitis was complicated by pulmonary edema progressing to the adult respiratory distress syndrome. Increased pulmonary shunt and pulmonary hypertension required high levels of positive end-expiratory pressure and prolonged mechanical ventilation to correct hypoxemia. A possible role for a cuffed endotracheal tube in epiglottitis is discussed.     

Adult acute epiglottitis and foreign body in the throat - chicken or egg?

A 53 year old man presented with the chief complaint of having a fish bone stuck in the throat for about 1 h. There was no dysphagia or respiratory symptoms. Plain lateral neck X-ray, direct laryngoscopy and oesophagogastroduodenoscopy showed a grossly swollen epiglottis with narrowing of the laryngeal lumen. No foreign body was found. His condition improved rapidly with intravenous antibiotic therapy. As acute epiglottitis may be a sudden life-threatening condition, a high index of suspicion should be maintained for patients who present with alleged foreign bodies in the throat.     

Acute epiglottitis in adults

Acute infectious epiglottitis, a serious life-threatening disease because of its potential for sudden upper airway obstruction, is most commonly seen in children, although it can occur in adults. Because acute epiglottitis is uncommon in adults, it is often misdiagnosed. Five cases are presented that demonstrate the clinical characteristics of adult epiglottitis. Knowledge of the symptoms and signs of the disease will lead to early diagnosis and appropriate management, thereby reducing morbidity and mortality rates.     

The hazard of acute epiglottitis

This report is based on a 3 1/2 year's study of 33 cases of acute epiglottitis with 3 child deaths. Suspicion of acute epiglottitis in children with respiratory distress is always an indication forrapid direct laryngoscopy under general anaesthesia with intubation, and preparation for tracheotomy and bronchoscopy.Should the diagnosis of acute epiglottitis not be excluded during this procedure, then a free airway should be ensured by endotracheal intubation, even in cases of apparently less severe character, where the procedure would seem to be more prophylactic than therapeutic. Intubation is often very difficult.It is concluded that the patient should be received at the hospital by an E.N.T. — anaesthetic team conversant with the treatment of this potential killer.     

Management of acute epiglottitis.

Airway obstruction secondary to acute epiglottitis is a dramatic, life-threatening emergency. Early diagnosis and provision of an adequate artificial airway are critical in the management of these patients. Tracheostomy has been the traditional method of securing the airway in acute epiglottitis, but more recently, endotracheal intubation has been advocated. Whichever method of airway management is preferred, it is imperative that every hospital have a protocol for the management of acute epiglottitis so that immediate action can be taken.     

Acute epiglottitis in the adult

GPs are often the first to see adults with acute epiglottitis, yet the information on how to treat them is not usually available. The seven cases presented here demonstrate a wide spectrum of severity with characteristic signs and symptoms. Diagnosis and management are discussed.     

Acute epiglottitis in the adult

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.     

Lingual thyroid and associated epiglottitis

A relatively rare genetic anomaly, lingual thyroid has a reported incidence of 1:100,000. Histologically, it may consist of normal or fetal-type tissue, and may show lymphoid infiltration. Differential diagnosis should include consideration of various benign and malignant diseases. We review diagnostic procedures as well as medical and surgical management, and present an illustrative case of lingual thyroid with associated epiglottitis.