Epiglottitis In Adults Research Articles

Infectious Acute Epiglotite: About 1 case in the Emergency Vital Service CHU- MOHAMED VI Marrakech

Acute infectious epiglottitis in adults is a rare but serious condition. For a long time, this condition was considered an illness of children between 2 and 6 years old. It can be seen in adults but remains misdiagnosed to this day, due to its misleading and polymorphic symptomatology in adults [1]. Inspiratory dyspnea associated with stridor is key signs to guide the diagnosis. Laryngoscopy and nasofibroscopy allow us to confirm the diagnosis [10]. Acute epiglottitis is an infectious and respiratory emergency that can be life-threatening due to obstruction of the upper airways [1]. It requires rapid treatment, which may even involve a tracheal approach. Naso or oro tracheal intubation and/or tracheotomy are emergency means used in severe acute epiglotitis. Antibiotic therapy also remains a therapeutic emergency and must be started early. We will report the observation of 1 case of a 46-year-old patient, admitted for acute inspiratory dyspnea of rapidly progressive onset, admitted to the Emergency vital Service of Chu Mohamed VI Marrakech.

Not Only Meningitis but Also Epiglottitis: An Emerging Clinical Presentation of Invasive Meningococcal Disease.

The rebound of invasive meningococcal disease cases in France since the fall of 2022 was accompanied by an increase in adult epiglottitis. These cases were provoked mainly by isolates of serogroup W belonging to the clonal complex 11 of Neisseria meningitidis. Awareness and surveillance should be reinforced.

Infectious and noninfectious epiglottitis in adults: our experience

Background: The present prospective study was conducted in the department of ENT at GMC Doda for a period of three years from February 2019 to March 2022. The study aimed at evaluating the causes, presentation and management of adult epiglottitis. Methods: The patients presenting with the sign and symptoms of epiglottitis were evaluated and were subjected to rigid/flexible endoscopic examination. Patients presenting with respiratory distress were categorized as per Freidman’s classification. Results: Epiglottitis was seen in 21 patients with 13 male and 8 female patients. The age distribution was between 26 and 68 years (mean, 44.4±11.3). Infection, as a cause of epiglottitis was present in 14 subjects and 7 patients had non infectiousetiology. Corrosive ingestion (HCL) and angioedema was seen in two patients each. Hot water aspiration, hot milk and foreign body aspiration (fish bone) was present in the rest of three patients each. Most common complaint of patients in our study was sore throat followed by painful swallowing and voice change. Conclusions: Epiglottitis in adults can be easily overlooked because of its non-specific presentation. Importance needs to be stressed upon the examination of larynx in patients presenting with sore throat not responding to conventional treatment or with symptoms of respiratory distress and voice change. Airway management should be take preference in patients having stridor before embarking on laryngeal examination with close Follow up.

Clinical characteristics and risk factors of recurrent acute infectious epiglottitis in adults

Objective:The purpose of this study was to investigate the clinical characteristics and risk factors of adult recurrent acute infectious epiglottitis. Methods:All patients diagnosed with acute infectious epiglottitis hospitalized in the Department of Otolaryngology, Hai'an People's Hospital, Nantong University from January 2012 to December 2019 were included. Results:The recurrence rate of 331 adult patients with acute infectious epiglottitis was 4.2% （14/331）, including 10 cases of once recurrence and 4 cases of twice recurrence. The onset time of all patients was within 48 hours. The most common main complaint in the recurrent group was sore throat （42.9%）, and dysphagia in the non-recurrent group （42.0%）. The frequency of drinking in recurrent group was higher than that in non-recurrent group （P=0.009）. The incidence of chronic obstructive pulmoriary disease（COPD）, diabetes, cyst and gastroesophageal reflux disease/laryngopharyngeal reflux disease in recurrent group was higher than that in non-recurrent group. There was no significant difference in other clinical features, treatment and prognosis between the two groups except tongue tonsil infection under laryngoscope. Multivariate analysis showed that frequent drinking （more than twice a week）, COPD, diabetes, cysts and lingual tonsillar infection were the risk factors for recurrence. Conclusion:Adult acute infectious epiglottitis has a proportion of single or multiple recurrence. Frequent drinking, COPD, diabetes, cyst and lingual tonsillar infection are the risk factors for the recurrence.

A Retrospective Cohort Study of Acute Epiglottitis in Adults.

IntroductionAdult epiglottitis is a disease process distinct from pediatric epiglottitis in microbiology, presentation, and clinical course. While traditionally considered more indolent and benign than in children, adult epiglottitis remains a cause of acute airway compromise with a mortality rate from 1–20%. Our objective was to characterize the disease course and evaluate the rate and type of airway management in this population at a tertiary, academic referral center.MethodsWe conducted a retrospective chart review of all adult patients (age ≥ 18) who were definitively diagnosed with infectious “epiglottitis,” “supraglottitis,” or “epiglottic abscess” by direct or indirect laryngoscopy during a nine-year period. Double data abstraction and a standardized data collection form were used to assess patient demographic characteristics, presenting features, and clinical course. The primary outcome was airway intervention by intubation, cricothyroidotomy, or tracheostomy, and the secondary outcome was mortality related to the disease.ResultsSeventy patients met inclusion criteria. The mean age was 50.2 years (standard deviation ± 16.7), 60% of the patients were male, and 14.3% were diabetic. Fifty percent had symptoms that were present for ≥ 48 hours; 38.6% had voice changes, 13.1% had stridor, 12.9% had fever, 45.7% had odynophagia, and 47.1% had dysphagia noted in the ED. Twelve patients (17.1%) received an acute airway intervention including three who underwent emergent cricothyroidotomy, and one who had a tracheostomy. Two patients died and one suffered anoxic brain injury related to complications following difficult airway management.ConclusionIn this case series the majority of patients (82.9%) did not require airway intervention, but a third of those requiring intervention (5.7% of total) had a surgical airway performed with two deaths and one anoxic brain injury. Clinicians must remain vigilant to identify signs of impending airway compromise in acute adult epiglottitis and be familiar with difficult and failed airway algorithms to prevent morbidity and mortality in these patients.

Short-Term Exposure to Air Pollution and Epiglottitis: A Nested Case-Control Study.

This study investigated the impacts of air pollution and meteorological factors on the occurrence of epiglottitis. A nested case-control study. Participants ≥40 years old in the Korean National Health Insurance Service-Health Screening Cohort were analyzed. A total of 2,615 epiglottitis patients and 10,460 matched control participants were analyzed. The odds ratios (ORs) for epiglottitis associated with meteorological and air pollution factors, including sulfur dioxide (SO2 , ppb), nitrogen dioxide (NO2 , ppb), ozone (O3 , ppb), and carbon monoxide (CO, ppm), after 3, 7, 15, and 30 days of exposure were analyzed using conditional logistic regression adjusted for total cholesterol, blood pressure, fasting blood glucose, obesity, smoking, alcohol consumption, prior upper respiratory infection, tonsillectomy, immunocompromise, autoimmune disease, and the Charlson comorbidity index. The daily temperature range and NO2 exposure after 3 days were associated with increased rates of epiglottitis (OR=1.03, 95% confidence interval [CI]=1.02-1.05 for temperature range and OR=1.78, 95% CI=1.14-2.77 for NO2 , respectively). These results were generally consistent at 7, 15, and 30 days. The temperature range and NO2 exposure for 3, 7, 15, and 30 days were positively related to the occurrence of adult epiglottitis. 3 Laryngoscope, 131:2483-2489, 2021.

Early recognition and critical management of adult epiglottitis in the emergency department: a case report and review of the literature

Background: Acute epiglottitis was considered a disease of the pediatric population. However, it has constantly been a report of a certain number of adult cases. Death by airway obstruction is caused by delayed diagnosis and untimely invasive airway management contributing to the higher mortality rate in adults. Case presentation: We presented a case of a 24-year-old male patient without significant underlying condition, who presented at our emergency department with a progressive sore throat and high-graded fever for one day. After a set of investigations, the patient was diagnosed with acute epiglottitis, and airway management was managed accordingly. His conditions improved after a course of antibiotic treatment during hospital admission. Conclusion: Acute epiglottitis in adults is not frequently encountered in the emergency department. This case underlines the importance of clinical suspicions in cases with consistent symptoms as well as the excellent utility of lateral neck radiography for the diagnosis of this life-threatening entity.

Intubation decision criteria in adult epiglottitis

ObjectivesTo identify contributive criteria in decision-making for intubation in acute epiglottitis, based on clinical and endoscopic data in adult patients, and to study clinical and biological characteristics and management. Materials and methodsDiagnosis was established by flexible endoscopy showing epiglottic edema in association with general signs of sepsis in 28 patients consulting into two French hospitals between 2005 and 2016. Retrospective univariate and multivariate analysis between patients managed by intubation (Group I) or surveillance (Group S) was performed on clinical and endoscopic data. ResultsTen patients were intubated (36%). On univariate analysis, 4 variables were suggestively associated with intubation. On multivariate analysis, associations remained suggestive for dyspnea (OR=50.6; 95% CI=[2.7; 940.1]) and supraglottic edema extension (OR=42.2; 95% CI=[2.2; 799.5]). The area under the curve identifying intubated patients on these 2 criteria was 90.8%, testifying to high discrimination. ConclusionIntubation must always be considered in epiglottitis. Dyspnea and supraglottic extension of the edema seem to be the two main criteria to be considered in airway control decision-making.

Out of hours use of awake videolaryngoscopy in the airway management of adult epiglottitis

Out of hours use of awake videolaryngoscopy in the airway management of adult epiglottitis

Regarding A Systematic Review and Meta‐analysis of Predictors of Airway Intervention in Adult Epiglottitis

Regarding <i>A Systematic Review and Meta‐analysis of Predictors of Airway Intervention in Adult Epiglottitis</i>

A systematic review and meta-analysis of predictors of airway intervention in adult epiglottitis.

Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease. The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random-effects model meta-analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention. Thirty studies and a total of 10,148 patients were finally included for meta-analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention. In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention. NA Laryngoscope, 130:465-473, 2020.

Adult epiglottitis: Trends and predictors of mortality in over 30 thousand cases from 2007 to 2014.

To characterize trends of adult epiglottitis presenting to the emergency department (ED) and analyze mortality. We utilized the National Emergency Department Sample to characterize adult epiglottitis from 2007 to 2014 and used provided weights to obtain nationally representative data (all presented data are weighted). Univariate and multivariate analyses were conducted to determine predictors of mortality. A total of 33,549 cases were identified (weighted). Over the study period, the average patient age increased significantly from 47 to 51 (R2 > 0.5), with an overall mean age of 49. A total of 11.8% of patients were coded as having obstruction, and 68.3% of cases were admitted to the hospital. Across all years, < 1% received laryngoscopic or airway procedures in the ED. Utilization of both X-ray and computed tomography was <10%. Over the 8 years, there were an average of 42 deaths per year (1.01% overall mortality). No clinical factors, except obstruction, were significant on univariate analysis (P < 0.05). Multivariate analysis indicated that patient age, degree of hospital urbanization, and smoking status also were nonsignificant. Epiglottitis is still a significant pathology seen in EDs, is stable over the study period, and carries a mortality risk. There is an exceptionally low rate of documented clinical interventions in the ED, especially compared with inpatient studies of epiglottis. This suggests a lack of recognition of the need and utilization of critical airway interventions early in the patient encounter. Future research is needed to characterize the reasons for the low rate of early airway visualization and intervention of epiglottitis in the ED. 4 Laryngoscope, 129:1107-1112, 2019.

A Lot to Choke on: Case of Adult Epiglottitis with Concurrent Peritonsillar Abscess in a Patient with a Sore Throat

BackgroundIn the winter months, one often sees a large increase in the volume of patients presenting to emergency departments with acute pharyngitis. While most cases of acute pharyngitis are benign, a rare minority can be life threatening. Case ReportWe report a case of epiglottis with a concomitant peritonsillar abscess (PTA) in an adult who presented to the emergency department with a sore throat. Computed tomography (CT) scan showed epiglottitis with a developing left PTA. The patient was treated with broad-spectrum antibiotics, high-dose steroids, and underwent multiple laryngoscopies with eventual resolution of his epiglottic swelling. Why Should an Emergency Physician Be Aware of This?This case serves to highlight the importance of physical examination and CT imaging in identifying patients with pharyngitis who can benefit from additional interventions and monitoring. It is also an unusual example of the presence of two likely related upper respiratory pathologies presenting in the same patient.

Management Dilemma: A Case of Acute Epiglottitis Secondary to Group A Streptococcus (GAS)

SESSION TITLE: Shock SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: In adults, epiglottitis has a male preponderance with the potential for rapid airway obstruction. Risk factors include hypertension, diabetes mellitus (T2DM), substance abuse and immune deficiency. CASE PRESENTATION: A 52-year-old male with history of T2DM, obesity and alcohol abuse presented with shortness of breath and choking sensation. Intubation was attempted in the ER for respiratory distress using a size 6 endotracheal tube. Chest X-ray revealed poor tube position despite multiple attempts to advance it. Epinephrine and pulse steroids were administered. Emergent bronchoscopy showed swelling of the supraglottis and an emergent tracheostomy was performed. Labs revealed leukocytosis with bandemia. Neck CT scan confirmed acute epiglottitis with critical airway stenosis. Bronchoalveolar lavage and blood cultures grew GAS. Bacteremia cleared two days after admission with Ceftriaxone and Vancomycin. Patient had spiking fevers and was noted to be extremely agitated. He received steroids for five days after a second CT neck revealed no interval change in edema.(Image 2) Two weeks after persistent fevers and hemodynamic instability requiring pressors, antibiotics were switched to Penicillin (PCN) G and Clindamycin without resuming steroids. After 24 hours, patient had significant clinical improvement and was subsequently weaned off the ventilator. He was seen in the clinic after discharge with complete resolution of symptoms. DISCUSSION: Multiple retrospective studies have noted that epiglottitis in adults can be managed conservatively with airway support required in only 6.6 - 16% of patients. We encountered a severe case of acute epiglottitis in an adult male who failed to respond clinically after two weeks of appropriate antibiotic coverage and a trial of steroids but responded to the addition of Clindamycin. The loss of penicillin binding proteins in ‘stationary growth phase’ bacteria occurs in more invasive streptococcal infections rendering PCNs less effective. Clindamycin suppresses bacterial toxin production, enhances opsonization, decreases cytokine activation and has a post-antibiotic effect.1 A recent in-vivo and in-vitro study endorsed the addition of Clindamycin to PCN in severe streptococcal infections.2 CONCLUSIONS: GAS epiglottitis can present in adults with risk factors: male sex, diabetics and substance abuse. With poor clinical response, complications such as toxic shock syndrome should be considered. The addition of Clindamycin to PCN in severe streptococcal infections may be beneficial with its action on slow growing bacteria and ability to inhibit bacterial toxin production. Reference #1: 1.Russell NE, Pachorek RE. Clindamycin in the treatment of streptococcal and staphylococcal toxic shock syndromes. Ann Pharmacother. 2000;34(7-8):936-939. Reference #2: 2.Andreoni F, Zürcher C, Tarnutzer A, et al. Clindamycin Affects Group A Streptococcus Virulence Factors and Improves Clinical Outcome. J Infect Dis. 2016;1:jiw229. DISCLOSURE: The following authors have nothing to disclose: Hisham Hakeem, Marnie Aguasvivas, Lokesh Dayal, Killol Patel No Product/Research Disclosure Information

Spontaneous Respiration Using Intravenous Anesthesia and High-Flow Nasal Oxygen (STRIVE Hi) Management of Acute Adult Epiglottitis: A Case Report.

High-flow nasal oxygen (HFNO) is a potentially life-saving adjunct in the emergency management of the obstructed airway. HFNO has multiple beneficial applications in critical care and respiratory support, but its use in emergency-obstructed airway management has not been defined. This case report describes spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen to successfully manage acute adult epiglottitis with rapidly progressing airway obstruction. Oxygenation, carbon dioxide levels, and airway patency were maintained, which facilitated endotracheal intubation while the patient was spontaneously breathing during general anesthesia. The application of HFNO can be extended to emergency airway obstruction.

Sudden Death Due to Acute Epiglottitis in Adults: A Retrospective Review of 11 Postmortem Cases.

We report a retrospective review of fatal acute epiglottitis cases in adults in the province of Ontario, Canada, between 2001 and 2014. Information on demographics, clinical history, gross, microscopic, and laboratory findings were collected and analyzed. Eleven cases, predominantly male (73%), with a mean age of 50 years were identified. Common presenting symptoms included sore throat, dysphagia, and low-grade fever. The predominant postmortem findings included hyperemia and edema of the epiglottis and aryepiglottic folds. Histological features included vascular congestion, stromal edema, and acute inflammation. Five cases (45%) were positive for growth of various bacterial organisms on blood and/or tissue cultures. Acute epiglottitis should be in the differential diagnosis in fatalities presenting with symptoms of upper respiratory tract infection, followed by an episode of acute shortness of breath. History, thorough postmortem examination with close attention to the head and neck structures, histological examination of tissues, and sampling for microbiology will assist in differentiating epiglottitis from other cases of laryngeal swelling leading to death.

Diagnosing Epiglottitis with Radiographs: Can we be More Objective?

Objective The classical radiographic signs in acute epiglottitis are qualitative. The purpose of our study was to identify objective radiographic parameters to aid diagnosis of acute epiglottitis in Chinese adults. Methods A case-control study of Chinese adult patients attending the accident and emergency department (AED) who were subsequently diagnosed to have acute epiglottitis from 1st January 2009 to 31st December 2013 in a public hospital in Hong Kong. Controls were one-to-one age- and sex-matched patients who attended the AED during the study period for orthopaedic problems with cervical spine radiographs taken. Cases and controls were retrieved from the hospital computer system and their radiographs were interpreted by two specialist radiologists with various pharyngeal and laryngeal parameters, including the dimensions of the third cervical vertebral body, epiglottis, aryepiglottic fold, hypopharynx, retropharyngeal soft tissue and retrotracheal soft tissue, measured and analysed. Sensitivity, specificity, positive and negative likelihood ratios were calculated for each of the parameters. Results Twenty-six patients and 26 age- and sex-matched controls were included in the study. Epiglottis width of 5.5 mm or more was found to be 96.2% sensitive and 100% specific in diagnosing acute epiglottitis. Positive and negative likelihood ratios were infinity and 0.04 respectively. Aryepiglottic fold width of 5.9 mm or more was 92.3% sensitive and 80.8% specific. Positive and negative likelihood ratios were 4.80 and 0.10 respectively. Conclusion The identified objective radiographic parameters should aid in the diagnosis of acute epiglottitis in Chinese adults. (Hong Kong j. emerg.med. 2016;23:168-175)

The Case Files

The Case Files

Challenges in Diagnosing Adult Epiglottitis: Limitations of CT scan

Adult Epiglottitis (AE) is a life-threatening but uncommon condition which presents with non-specific symptoms such as sore throat and odynophagia. Because CT scan is readily available in the Emergency Department (ED), it is often used to evaluate adult patients with AE when laryngoscopy is not available and examination inadequate and to exclude other ENT (Ear, Nose and Throat) emergencies. However, up to this date, there is no report of CT scan accuracy in evaluating AE in our literature. Our case is a 26 year old African American female who complains of sore throat and odynophagia after she ate at a barbecue 8 hour prior to the ED visit. On examination, VS (Vital Signs) were stable, throat revealed marked erythema without any peritonsillar abscess. Neck was supple without any cervical adenopathy - Chest=clear, no rales/ronchi - The rest of the exam was within normal limits. Initial CT scan of the neck was read as normal by the on call Radiologist. A direct laryngoscopy had shown findings consistent with acute epiglottitis. Repeat CT scan 24 hours after ED visit confirmed the diagnosis of AE. Patient was started on IV steroids and antibiotics and admitted to ICU. Our case illustrates the challenges facing the Emergency Physicians in diagnosing AE. It reports the role and limita- tions of CT scan in evaluating AE in the ED.

Acute Epiglottitis in Adults: a Case Series

Acute Epiglottitis in Adults: a Case Series