Epiglottitis in the adult

Abstract

Acute epiglottitis in adults is probably commoner than is generally appreciated. Although upper airway obstruction can occur, the course most often is benign. Acute epiglottitis should be suspected in all patients with a sore throat and dysphagia, especially if symptoms are out of proportion to pharyngeal findings. Diagnosis can be established by mirror or flexible fiberoptic laryngoscopy, lateral radiography of the neck, or both. Treatment consists of maintenance of a patent airway and use of humidified oxygen and antibiotics (ampicillin and chloramphenicol [Chloromycetin] ). The role of corticosteroids in treatment of epiglottitis is still controversial.

Case and Literature Review: Adult Acute Epiglottitis – Rising Incidence or Increasing Awareness?

“…46,49 Indirect mirror, direct or flexible laryngoscopy are more accurate and have not been found to precipitate airway obstruction. 5,15,39,45,50,51 The laryngoscopic appearance of adult epiglottitis has been described as a "red cherry". 52 An increased awareness of this condition accompanied by the widespread use of nasopharyngolaryngoscopy may have contributed to the identification of more cases with a wide spectrum of disease severity.…”

“…6,37,[54][55][56] Adult acute epiglottitis is different from its paediatric counterpart in that organism identification (both throat and blood culture) is less common, the clinical course is more gradual, there is less seasonal variation, air way compromise is more uncommon, and conservative airway management can be contemplated in selected patients. 6,8,15,39,45,57 Incidences of "sudden" upper airway obstruction and death resulted in some authors recommending prophylactic intubation in all patients diagnosed with adult epiglottitis. 7,58 However, the general consensus is that adult epiglottitis without respiratory symptoms or drooling can be managed safely in an intensive care setting with a selective approach to airway intervention for any patient with signs of critical airway compromise within 8-24 hours after onset.…”

“…10 Odynophagia and dysphagia out of proportion to the pharyngeal inflammation is the typical presentation. 5,39,40 There may be fever, toxic appearance, cervical lymphadenopathy, anterior neck and chest cellulitis. 10,41 Fever may be absent in 12-40% of patients.…”

Acute supraglottic laryngitis in adults

“…The diagnosis in adults is usually made on indirect laryngoscopy or by fibro-optic laryngoscopy. If this is not feasible, a lateral X-ray view of the neck will show the epiglottic swelling, but again quoting Cohen (1984), a patient suspected of having acute epiglottitis should not have respiratory arrest in the radiology suite! Once the diagnosis is made, the management in adults may differ from that in children.…”

“…Andreassen et al (1984) found half of their patients with epiglottitis to be adults and stated that sudden airway obstruction may occur in grown-up patients as well as in children. Cohen (1984) thinks that acute epiglottitis in adults is probably commoner than is generally appreciated, and although upper airway obstruction can occur, the course is most often benign. Khilanani and Khatib (1984) reviewed 158 cases of adult epiglottitis reported in the English Literature and, reporting on four cases of their own, found that an infectious aetiology was identified in only 29 cases (Haemophilus influenzae, 20; Streptococcus pneumonia, 6; Haemophilus parainfluenzae, 2; and streptococcus pyogenes, 1).…”