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.     

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 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: 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.     

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 the adult.

Acute epiglottitis in the adult is a rare disease, which has shown an appreciable increase since the sixties and in our locality since 1984. We present a review of the cases registered in our hospital, analyzing their aetiology, evolution and treatment. The disease is most likely to be suspected in the presence of any patient having a sudden dysphagia, especially if he shows symptoms of an acute infection and a lack of oropharyngeal pathology.     

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 infectious epiglottitis in children and adults: annual incidence and mortality

The incidence and mortality of acute epiglottitis were retrospectively analysed covering a 12-year period, 1975-1987. The diagnosis was made by the laryngoscopic findings in 95% of patients. Based on 902 hospitalized patients, a mean annual incidence of 4.9 cases per 100,000 children and adults was found. Although adult patients predominated (60%), the incidence was far higher in children, 13.8 per 100,000 compared with 3.9 per 100,000 in adults. Two peaks in incidence were identified, one for the youngest children, and the second for young adults (15-29 years). Over the years the incidence varied little in adults, but decreased significantly in children over the last 6 years studied. The data presented indicate acute epiglottitis to be a more frequent disorder than previously believed but with less risk of a fatal outcome. The mortality rate was below 1% in children and adults and the annual incidence of death from acute epiglottitis was estimated at 0.5 cases per million. The primary admission of these patients to ENT units seems to be the single factor having the most powerful impact on mortality.     

Acute uvulitis in combination with acute epiglottitis: a case presentation

Acute uvulitis in adults is a rare condition, especially when associated with acute epiglottitis. Watchful monitoring of the airway, usually in the intensive care unit, is recommended. Along with appropriate antibiotics and steroids, we recommend all patients with acute uvulitis have a lateral radiograph of the neck to rule out acute epiglottitis. To avoid a possible fatality, a high index of suspicion should be maintained at all times in order to appropriately diagnose and treat these patients.     

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.     

Orbit complications of sinusitis in adults. Our cases during 10 years

The sinusites orbital complications usually associated to ethmoidites are rare in the childhood. We present a revision of 14 adults patients (10 males and 4 females) 18 to 61 years old. Seven presented a preseptal cellulitis, two had a subperiostial abscess and five an orbitary cellulitis in accordance with the Candler classification. We analyse the personal previous history, the clinical data, complementary tests and treatments (medical and surgical) evolution and hospital stay. We realise a literature revision about this subject.     

成人急性会厌炎临床分析

目的探讨成人急性会厌炎的临床特点、治疗和预后。方法本研究共纳入75例成人急性会厌炎患者,治疗采用足量抗生素和糖皮质激素,其中6例行气管切开术。结果本组75例急性会厌炎患者最常见症状为咽痛(100%)、吞咽痛(100%)、吞咽困难(96%),65.33%的患者感呼吸困难;全部患者治疗后均获得痊愈,8%的患者予以气道干预;有糖尿病组气管切开率高于无糖尿病组(P<0.05)。结论①当患者感明显的吞咽痛而口咽部未见明显异常时,勿忘检查喉部,以免遗漏急性会厌炎;②病情发展快,IV度呼吸困难预示需进行气道干预;③伴糖尿病的成人急性会厌炎较无糖尿病者易发生急性上呼吸道梗阻;④绝大多数成人急性会厌炎患者可通过保守治疗得以痊愈。