No abstract

Acute supraglottic injury can be mistaken for acute epiglottitis, particularly in the patient unable or unwilling to provide a history. This dilemma is heightened by recent reports that acute epiglottitis may be more common in adults than previously believed. 1,2 In addition, acute epiglottitis in the adult has a relatively unpredictable presentation. 3 We present injuries mimicking acute epiglottitis in two mentally impaired adult patients. CASE REPORTSCase t. A 51-year-old male institutionalized schizophrenic came to the emergency department approximately 6 hours after swallowing a hot tomato. He reported pain in his throat, dysphagia, and drooling during the previous several hours. On examination, the patient was drooling but had no stridor or apparent airway distress. His temperature was 100.2 ° F orally. Examination showed no obvious burns or lesions of the oropharynx. Indirect laryngoscopy revealed a swollen epiglottis covered with yellow exudate. The true vocal cords were normal in mobility. A swollen epiglottis was seen on lateral neck radiograph.The patient was admitted and placed on airway precautions. He began receiving intravenous ampicillin/sulbactam. Throughout 5 days of hospitalization his temperature defervesced, and his tolerance of oral intake gradually improved. Repeat indirect laryngoscopy was performed each day and revealed progressively less erythema and exudate of the epiglottis. On the day before discharge, the patient still exhibited a moderate amount of epiglottic edema; however, this had been remarkably reduced since admission. The patient remained afebrile with adequate oral intake and a stable airway. He was subsequently discharged from the hospital and continued receiving Augmentin 500 mg orally four times daily for 14 days. Examination at 3.5 weeks showed no residual injury.

The presence of dysphagia, drooling, and stridor in an adult subsequent to thermal or caustic injury should alert the treating physician to the possibility of injury to the supraglottic structures with resultant epiglottitis. These adults possess many of the features seen in acute infectious epiglottitis and should be handled with the same consideration for potential upper airway obstruction. Epiglottic injuries of this type should be suspected in adults with mental disorders or communication difficulties.