Acute Adult Supraglottitis: An Impending Threat to Patency of Airway and Life

Abstract

Introduction Acute adult supraglottitis (AAS) is one of the upper airway infections that can potentially cause upper airway obstruction and, if not treated promptly, can be life-threatening. The widespread use of vaccines against Hemophilus influenzae has decreased the incidence of epiglottitis in children, whereas the incidence of AAS is on the rise. We aim to highlight the presentation, diagnosis, and management in AAS with our study. Patients and Methods A retrospective analysis was performed on all patients admitted to a tertiary health care facility surgical intensive care unit (SICU) where AAS was identified and the demographic data, duration of symptoms, imaging studies, management, and complications were recorded. In these patients, the diagnosis of AAS was confirmed by nasopharyngeal endoscopy. Data was entered in the IBM Statistical Package for Social Sciences (SPSS), version 23 (IBM SPSS Statistics, Armonk, NY), and groups were compared using student t-test and chi-square test. P values of ≤ 0.05 were considered statistically significant. Results A total of 118 patients were admitted to the SICU. The male: female ratio was 3.9: 1. Major risk factors were smoking and drinking cold liquids. The common presenting symptom was sore throat (89.8%). The thumb sign was positive in 65% of the patients. Common bacteria were the Streptococcus species (11.9%). Ceftriaxone was the most commonly prescribed inpatient antibiotic. All patients received steroids as adjuvant therapy. Adrenaline nebulization was used in 66% of the cases. Forty-six percent of patients required endotracheal intubation. In 10.2% of patients, intubation was not possible and in 12.7% of patients, a tracheostomy was done. Ludwig’s angina was the most frequent complication. Patients presenting with dysphagia and fever had a significantly higher incidence of Ludwig’s angina (P ≤ 0.02 and 0.005, respectively). AAS patients complicating into Ludwig’s angina (severe cellulitis of submandibular, submental, and sublingual spaces) had a significantly longer duration of symptoms, a higher incidence of streptococcal infection, airway interventions, and prolonged stay in an intensive care unit (p ≤ 0.05). Conclusion Male gender, smoking, and drinking cold liquids were the risk factors associated with AAS, and thumb sign on lateral neck soft tissue x-ray was suggestive of it. AAS caused by Streptococcus species was a relatively serious condition, leading to complications like Ludwig’s angina.

Acute infectious supraglottitis in adult population: epidemiology, management, outcomes and predictors of airway intervention

“…Epidemiological analyses revealed a male to female ratio of 2.03:1 in our cohort, which is consistent with previous studies that reported ratios from 1,1:1 to 4:1. [ 3 , 6 , 7 ], showing a higher proportion of supraglottitis in male population. The mean age at diagnosis of our patients was 53 years, with similar results to others published [ 1 , 4 , 8 – 10 ].…”

Monkeypox presenting as supraglottitis in an immunocompromised patient

“…7 Severe sore throat with associated systemic signs of infection may be a sign of supraglottitis, a potentially life-threatening disease characterised by inflammation and oedema of the supraglottic structures of the larynx. [8][9][10] There is a risk of rapidly progressive airway compromise, requiring emergency intubation or tracheostomy, or potential respiratory arrest. [8][9][10] Immunocompromised patients are at higher risk of supraglottitis.…”

“…[8][9][10] There is a risk of rapidly progressive airway compromise, requiring emergency intubation or tracheostomy, or potential respiratory arrest. [8][9][10] Immunocompromised patients are at higher risk of supraglottitis. Our patient had some concerning features for supraglottitis (drooling and hoarse voice).…”