Adult epiglottitis: 6 years experience in a university teaching hospital in Hong Kong

Abstract

Adult epiglottitis is a relatively rare but potentially lethal disease. It seems to be increasing in incidence in other countries. The objective of this study was to examine the common presentations and clinical course of adult epiglottitis in Hong Kong. Retrospective review of 80 consecutive cases of adult epiglottitis admitted between 2000 and 2005. A rising trend in the incidence of adult epiglottitis was observed. The mean age (SD) was 49 years (15.7) and the male-to-female ratio was 2.5:1. Disease presentation was nonspecific and sore throat was the most common symptom. All patients were admitted to hospital; 47 (59%) patients were admitted to the intensive care unit (ICU) and 31 (39%) had provision of an artificial airway. Mean (SD) length of stay in ICU and hospital was 1.9 (2.2) and 6.3 (2.9) days, respectively. Six patients (7.5%) were complicated by epiglottic abscess formation. No deaths occurred in this series. Patients who required airway intervention had a higher ICU admission rate and a higher bacterial identification rate. Flexible laryngoscopy was more sensitive than lateral neck radiography in diagnosing epiglottitis (100 vs. 81.4%). The laryngoscopic finding of a narrowed airway was strongly related to the requirement for airway intervention (odds ratio=23.7, 95% confidence interval=4.2-132.6, P<0.001). A high index of suspicion is required for making the diagnosis of adult epiglottitis. Proper airway assessment and close monitoring are of the utmost importance in patient management. Flexible laryngoscopy is the key investigation of choice in the emergency department.

Comorbidities and complications influence the diagnosis and management of geriatric supraglottitis

“…Previous studies have demonstrated that 8% to 39% of patients with supraglottitis require airway management [1][2][3]6,[14][15][16][17][18]. In our study, the physicians secured the airways of 26% of the patients in the ED; and no further airway managements were required during hospitalization.…”

“…The strategy for airway management for adult supraglottitis patients remains controversial because there are no reliable predictors of sudden airway obstruction in these patients [4,[14][15][16][17][18]. Previous studies have demonstrated that 8% to 39% of patients with supraglottitis require airway management [1][2][3]6,[14][15][16][17][18].…”

Use of Bedside Sonography for Diagnosing Acute Epiglottitis in the Emergency Department

“…It may prove to be a rapid, noninvasive, and effective diagnostic tool for identifying and measuring the epiglottis 2 . Although the incidence of acute epiglottitis is very rare, the disease can be progressive and life threatening; therefore, early and safe diagnosis is required 1 , 2 , 5 . Conventional radiography cannot usually be performed on critically unstable patients in the intensive care unit or even in the ED.…”

Epiglottic abscess

“…Epiglottic abscess occurs almost exclusively among adults, and management of epiglottitis with abscess can be more complicated than epiglottitis alone, although studies report conflicting data regarding mortality. According to a seminal case review in 1977, mortality in patients with epiglottic abscess can be as high as 30%, although some more recent series report no fatalities [6][7][8]. Although the literature varies considerably in the estimation of its incidence and outcomes, epiglottic abscess is a potentially life-threatening condition that requires prompt diagnosis and appropriate treatment.…”

“…The treatment for both epiglottitis and epiglottic abscess involves airway management and antibiotics, but the presence of abscess may complicate airway management. Reported treatment modalities include artificial airway [8], incision and drainage [15][16][17], and spinal needle aspiration [7], in addition to medical therapy and observation (ie, conservative therapy or watchful waiting). Clinical decision making regarding interventional vs conservative therapy is multifactorial and should consider the degree of obstruction and likelihood of developing life-threatening airway compromise; the patient's medical status and comorbidities; and, if conservative therapy is considered, the ability of caregivers to detect and respond to sudden-onset respiratory distress.…”