Adult Epiglottitis in a Canadian Setting

Abstract

The objective of this study was to determine stable estimates of the incidence, case fatality, and epidemiologic features of adult epiglottitis, and risk factors for intubation. The authors designed a retrospective cohort combined with a nested case-control study, followed by detailed analysis of cases from two tertiary care institutions. Among 813 cases, the incidence was 2.02 cases/10(5) population per year. Ten recorded deaths constituted a case fatality rate of 1.2% (95% confidence interval [CI]: 0.5% to 1.9%). The eight fully documented deaths indicated no sudden episodes of catastrophic upper airway obstructions without previous dyspnea. A detailed review of 51 cases revealed that 18% of patients underwent expeditious intubation. Patients managed without initially requiring intubation did not need emergency airway interventions. Only the presence of dyspnea (noted in 29% of patients) at the time of admission (P < 0.001) predicted the need for intubation. A low case fatality rate in a conservatively managed cohort and the absence of sudden upper airway catastrophes in patients without dyspnea suggest that prophylactic intubation and intensive care unit monitoring is not warranted in all patients. An early complaint of dyspnea may safely discriminate between patients requiring invasive airway management and close observation.

Anaesthetic management of acute airway obstruction

“…Infective causes include Ludwig's angina, (9) wall abscess, (10) and acute epiglottitis. (11) Inflammatory causes include subglottic/tracheal stenosis, (7) goitre (12) and lingual tonsillar hypertrophy. (13) Neoplastic causes include laryngeal or tracheobronchial cancers, (14) and those associated with mediastinal mass syndrome.…”

Diagnosis and management of supraglottitis (Epiglottitis)

“…In contrast, some evidence suggests that the incidence of AS in adults is increasing, with the reported annual incidence rising from 0.79 cases/100,000 in 1986 [2], to 1.8 cases/100,000 in 1990 [13], 2.02 cases/100,000 in 1998 [7], and 2.1 cases/100,000 in 2005 [12••].…”

“…Most adults with AS present in their 40s and 50s, with a definite male preponderance [6,7,14]. Most childhood AS cases present between the ages of 2 and 5 years [10,11].…”

“…Subsequently, the disease has again become more common in adults than in children, and the focus has shifted back to AS in adults. Several reports show an increasing incidence of AS in adults [2,[6][7][8]. During the past 6 to 7 years, the incidence of AS in children in the United Kingdom has appeared to be increasing again [9].…”

Pseudomembranous supraglottitis with airway compromise in a patient with recurrent tonsillar carcinoma

“…5 The microbiology of adult supraglottitis is also quite different from pediatric epiglottitis because H. influenzae is not the bacterial pathogen responsible for the vast majority of adult cases. 5,8 Most cases of adult epiglottitis occur in previous healthy adults, 3,5,[8][9][10][11][12] although hypertension, diabetes mellitus, immunosuppression, and the presence of an active substance abuse disorder have also been identified as predisposing risk factors. 5,9,13 In this report, we discuss a patient with acute pseudomembranous supraglottitis complicating recurrent tonsillar carcinoma and describe the ramifications of these disorders on perioperative management.…”