Clinical study of acute supraglottitis as a disease entity

Abstract

Adult supraglottitis is an acute inflammation of the supraglottic structures first reported by Shapiro et al. While multiple anatomical sites in the larynx and oropharynx are inflamed, the epiglottis is not always the most involved area. In this paper, we refer to "adult supraglottitis" as "acute supraglottitis" because pediatric supraglottitis is rare in Japan. There have been no reports of acute supraglottitis in Japan to date. We report a clinical study of 15 cases of acute supraglottitis. In addition, we investigated whether acute supraglottitis can be recognized as a special form of acute laryngitis, the same as epiglottitis. Thirteen of 15 patients had severe sore throat or pain on swallowing. Oropharyngeal and laryngeal examinations revealed that the most involved area in the oropharynx and larynx was the aryepiglottic folds and the arytenoids. Five patients with edema extending from the aryepiglottic folds to the arytenoids complained of referred otalgia on swallowing. Strep. Pyogenes, Strep, pneumoniae, alpha-strep., and Staph aureus were isolated from the oropharynx. All patients were hospitalized because of severe presenting symptoms. Treatment consisted of intravenous antibiotics, including piperacillin, clindamycin, flomoxef, aspoxicillin, and cefotiam. Nine patients also received intravenous steroids. Signs and symptoms of supraglottitis resolved within 10 days in every case. No patient required airway intervention. Acute supraglottitis manifested more severe clinical symptoms than acute laryngitis. the local inflammatory findings of this disease were different from those of acute laryngitis and epiglottitis. therefore, we propose that acute supraglottitis is a special form of acute laryngitis.