Epiglottitis In Adults Research Articles

Infectious and Noninfectious Causes of Epiglottitis in Adults, Review of 24 Patients.

The present study reports the etiological differences, clinical features, management, and patient outcomes between infectious and noninfectious causes of epiglottitis in adult patients. The medical records of 24 patients with infectious and noninfectious epiglottitis were investigated. Diagnosis was made by anamnesis and endoscopic examination. On admission, respiratory distress of patients was classified according to Freidman's classification. Fifteen patients were male, and nine patients were female. Their ages ranged between 24 and 69 years of age (mean, 43.4±11.6). In total, 16 patients were diagnosed with infectious epiglottitis, and eight patients were diagnosed with noninfectious epiglottitis. Of patients with noninfectious epiglottitis, two had angioedema, two had experienced organophosphate ingestion, one had experienced hot water aspiration, one had experienced hot milk aspiration, one had experienced foreign body aspiration (fishbone), and one had epiglottitis due to Behçet's disease. Sore throat was the most common symptoms of infectious and noninfectious epiglottitis in our patients. Odynophagia was the second most common symptom of infectious epiglottitis, and muffled voice was the second most common symptom in noninfectious patients. Epiglottit is an emergency situation; when a patient is diagnosed with epiglottitis, close follow-up should be performed, and airway support should properly be maintained according to the degree of respiratory distress. Tracheostomy should be performed without hesitation, as needed.

Sudden Death from Acute Epiglottitis and Epiglottic Abscess in Adult

Acute epiglottitis and epiglottic abscess are forms of acute inflammation of the epiglottis and adjacent structures. They are potentially life-threatening conditions and likely to be underdiagnosed or misdiagnosed in adults. Traditionally, acute epiglottitis is regarded as a disease of children; however, its prevalence among children has decreased owing to vaccination. In contrast, the prevalence of adult epiglottitis has increased steadily. Moreover, epiglottic abscess formation is not an uncommon complication of adult epiglottitis. Epiglottic abscess is reported to be a predictor of airway obstruction and immediate airway intervention is needed in this clinical situation [1]. Herein, we describe the autopsy findings of two cases of sudden death from acute epiglottitis complicated by epiglottic abscess in adults, identified during postmortem examination.

Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database.

The aim of the study was to evaluate the factors associated with the development of severe epiglottitis in adults to provide information for physicians to make early decisions on airway management. Retrospective cohort study. Adult patients admitted to acute care hospitals with a diagnosis of acute epiglottitis between January 2011 and December 2012 were identified in the Diagnosis Procedure Combination database of Japan. The main outcome measures were: 1) severe epiglottitis requiring airway intervention or resulting in early death within 2 days after admission and 2) 2-day mortality. Multivariable logistic regression analysis was performed to evaluate the association between patient characteristics and development of severe epiglottitis. A total of 6,072 epiglottitis patients from 599 hospitals were identified. The proportion of developing severe epiglottitis was 9.4%, and 2-day mortality was 0.4%. Factors significantly associated with severe epiglottitis were older age, male sex (adjusted odds ratio [OR] 1.60; 95% confidence interval [CI], 1.28-2.00; P < .001), body mass index (BMI) >25.0 kg/m(2) (OR 1.31; 95% CI, 1.05-1.63; P = .018), diabetes mellitus (OR 1.41; 95% CI, 1.06-1.86; P = .017), epiglottic cyst (OR 2.90; 95% CI, 1.46-5.78; P = .002), pneumonia (OR 2.90; 95% CI, 1.73-4.86; P < .001), and academic hospitals (OR 1.56; 95% CI, 1.21-2.00; P = .001). Epiglottitis-related admission was summer-dominant, but seasonality was not significantly associated with severe epiglottitis. Development of severe epiglottitis was significantly associated with older age, BMI >25.0 kg/m(2), diabetes mellitus, epiglottic cyst, or pneumonia at admission. 2b.

Adult epiglottitis complicated by negative pressure pulmonary edema

Adult epiglottitis complicated by negative pressure pulmonary edema

A novel case of adult, acute epiglottitis successfully treated with noninvasive ventilation.

Acute adult epiglottitis is a rare and potentially fatal upper airway condition, requiring prompt recognition, resuscitation, stabilization, and transfer to definitive care. Treatment centers on skilled airway management and early antimicrobial therapy. We describe a patient with acute adult epiglottitis in whom airway management using noninvasive positive pressure ventilation was successful allowing avoidance of tracheal intubation.

A clinical study of acute epiglottitis in adults

Acute epiglottitis may trigger death because of serious airway obstruction. It is necessary to perform emergency and accurate airway intervention. In this retrospective study we present 216 cases of acute epiglottitis in adults. Airway management was done in 39 cases (18.1%), but most cases were treated conservatively. The mean patient age was 53 years and the male-to-female ratio was 1.9 to 1.0. The most frequent symptoms were sore throat (88%). The mean duration from symptom onset to consultation to our hospital was 1.9 days in the airway management group and 2.9 days in the conservatively treated group, which was statistically significant (p<0.05). Focusing on epiglottal swelling seen under the flexible laryngoscope, the percentage of airway management was 52.6% for swelling of the unilateral false vocal cords and 12.9% for swelling of the aryepiglottic fold. A statistically significant difference was also seen in complaints of respiratory difficulties (p<0.01), the rise of WBC (p<0.01), the rise of CRP (p<0.01), and diabetes mellitus (p<0.01).

Acute Epiglottitis in a 79‐Year‐Old Man

Acute Epiglottitis in a 79‐Year‐Old Man

176 Epiglottitis in Adults: A Systematic Review of Mortality and Airway Intervention in the Post-vaccine Era

Background: Epiglottitis is traditionally thought of as an airway emergency of childhood. With the advent of the Haemophilus influenzae type B (HIB) vaccine, the prevalence in childhood has decreased, but appears to be increasing in adults. Most studies of epiglottitis in adults are small, making it difficult to draw conclusions on the course of disease in this population.

A Rare Case of Acute Epiglottitis Due to Staphylococcus aureus in an Adult

Epiglottitis has been mainly associated with childhood infection with Haemophilis influenzae type B but cases of adult epiglottitis are increasing. We report here a case of adult epiglottitis and present evidence that it was caused by Staphylococcus aureus. A 48-year old patient with clinical symptoms of epiglottitis grew Staphylococcus aureus in pure culture from an epiglottal swab. Staphylococcus aureus should be considered as a potential pathogen in adult epiglottitis.

Management of acute epiglottitis in adults

Management of acute epiglottitis in adults

Acute epiglottitis complicated with pharyngeal abscess and recurrent acute airway obstruction in an adult

Acute epiglottitis is a common condition in children but is a rare entity in adults. Both in children and adults this is a life threatening condition as it can lead to complete airway obstruction. It is therefore vital that this condition is kept in mind when patients, both children and adults are admitted with severe airway obstruction to the emergency room. A case of adult acute epiglottitis complicated with abscess formation is described where timely intervention and correct diagnosis with appropriate treatment saved the life of the patient. Key words: Acute epiglottitis; Acute airway obstruction; Deep neck abscess DOI: 10.4038/slja.v19i1.2872 Sri Lankan Journal of Anaesthesiology Vol.19(1) 2011 pp.47-50

Two Cases of Acute Epiglottitis in Children Treated with Airway Control

Acute epiglottitis can produce airway obstruction, so we must usually treat these patients immediately with airway control. In Japan, acute epiglottitis in adults is common, but acute epiglottitis in children is very rare. In this paper, 2 cases of acute epiglottitis in children are reported. One patient was a 3-year-old boy. He visited our hospital complaining of dyspnea, trouble with speaking and stridor. Fiberscope examination of the larynx revealed severe swollen epiglottis, so we diagnosed acute epiglottitis. We immediately performed a tracheotomy to maintain the airway. After 5 days, the swollen epiglottis had improved and the patient recovered completely within 10 days. We detected Haemophilus influenzae from the blood cultures. The other patient was a 2-year-old girl. She visited our hospital complaining of dyspnea and stridor. Fiberscope examination of the larynx revealed a moderately swollen epiglottis, so we diagnosed acute epiglottitis. We immediately performed tracheal intubation to maintain the airway. The next day, the swollen epiglottis had improved and she recovered completely within 10 days. We detected Haemophilus influenzae from the blood cultures. We describe the diagnosis and treatment of acute epigolottitis in children, especially with regard to airway control.

Acute Epiglottitis in Adults: A 10-Year Review

Acute Epiglottitis in Adults: A 10-Year Review

The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis

To evaluate the effects of a coexisting epiglottic cyst on the clinical course and airway management of acute epiglottitis in adults. A review of the airway risk factors were studied in adults with acute epiglottitis in South Korea from 1997 to 2009. Retrospective chart review. Academic tertiary care referral medical center. The study included 117 adult patients that were diagnosed with acute epiglottitis laryngoscopically over a period of 12 years. Two distinct groups were identified: one with acute epiglottitis associated with an infected epiglottic cyst (n = 29, 25%) and the other with acute epiglotittis without a cyst (n = 88, 75%). Patient background data, clinical manifestations, laboratory data, airway management, outcomes, and recurrence were recorded. Eight (28%) out of 29 patients with an infected epiglottic cyst required airway intervention compared to the four (5%) out of 88 patients without a cyst. The difference between the two groups was statistically significant (P = 0.001). Five out of six patients with recurrent acute epiglottitis had a coexisting epiglottic cyst. The recurrence of acute epiglottitis in patients with a cyst was significantly more frequent (P = 0.003). Twelve patients (10%) required airway intervention. There was no mortality found in this study. Logistic regression analysis showed that an older age, dyspnoea, a high pulse rate, and the presence of an epiglottic cyst were associated with an increased risk for airway obstruction. The results of this study showed that a pre-existing epiglottic cyst might be associated with a suppurative infection of the supraglottis. Infected epiglottic cysts increased the risk for airway obstruction and recurrence of acute epiglottitis.

Adult Acute Epiglottitis: Predictors for Airway Intervention and Intensive Care Unit Admission

Objectives(1) to characterise the clinical features of acute epiglottitis in adults in Hong Kong; (2) to identify predictors for airway intervention and uneventful recovery without intensive care unit (ICU) admission. Modified Early Warning Score (MEWS) was also applied in risk stratification.MethodsA retrospective cohort study of 122 consecutive laryngoscopically confirmed cases admitted to Pamela Youde Nethersole Eastern Hospital from 1998 to 2007.ResultsThe mean patient age was 51 years (range 18–84 years) and the male‐to‐female ratio was 1.9 to 1. Sore throat, dysphagia and odynophagia were the commonest symptoms and the median MEWS on presentation was 1 (range 0–10). Nine patients (7.4%) required airway intervention (5 orotracheal intubations, 2 nasotracheal intubations and 2 tracheostomies) and one patient died. Univariate analysis showed that recurrent attack (OR 35.0, 95% CI 2.77–442.69, p=0.013), dyspnoea (OR 17.41, 95%CI 2.09–144.79, p=0.001), stridor (OR 30.0, 95%CI 2.42–372.65, p=0.016) and MEWS equal to or greater than 4 (OR 5.81. 95%CI 1.16–29.17, p=0.049) were significantly associated with airway intervention. Only stridor remained a reliable predictor in multivariate analysis (OR 88.46, 95%CI 5.48–1427.45, p=0.001). Performance of MEWS in prediction for airway intervention was evaluated with the Receiver Operating Characteristic (ROC) curve. The area under curve (AUC) was 0.71 (95%CI 0.503–0.909). Forty‐five patients did not require ICU admission (36.9%). Multiple logistic regression showed that absence of hoarseness (OR 3.10, 95%CI 1.10–8.79, p=0.033), absence of fever (OR 3.2, 95%CI 1.25–8.16, p=0.015) and MEWS &lt;1 (OR 7.07, 95%CI 1.31–38.07, p=0.023) were predictors of uneventful recovery without ICU care.ConclusionA selective approach should be adopted in airway management but those with stridor on presentation should have their airway secured without delay. MEWS cannot replace clinical judgement but a low MEWS on presentation may help in identifying low risk patients who can be managed safely without ICU admission.

Acute epiglottitis in adults — a recent review in an Indian hospital

To examine the mode of presentation, clinical course and treatment of acute epiglottitis in a series of adult patients. All adults with acute epiglottitis admitted to teaching hospital over a period of 12 months were included in this retrospective study. The diagnosis of epiglottitis was eatablished by laryngoscopy and soft tissue X-ray neck lateral view. Twelve patients were included. Three patients had concurrent acute tonsillitis. Blood cultures were negative in all the cases. Pathogens were isolated by throat swabs only in three patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of coamoxy-clav and metronidazole was the most common antibiotic regimen used. The rising incidence of acute epiglottitis in the adults necessitates the close observance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with more than 50% airway obstruction.

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

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.

Adult epiglottitis: is there a consensus on diagnosis and treatment?

Adult epiglottitis: is there a consensus on diagnosis and treatment?

Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong

Objectives:Acute epiglottitis in adult is a potentially life-threatening condition that may be underdiagnosed. The present study reports the clinical features, management and patient outcomes in an acute hospital in Hong...

Acute epiglottitis: epidemiology, clinical presentation, management and outcome

To describe the incidence trends, clinical presentation, management and outcome of acute epiglottitis in a Danish population after the introduction of Haemophilus influenzae type b vaccine. Retrospective review of the health records of all patients discharged with a diagnosis of acute epiglottitis from the otolaryngology department, Roskilde County Hospital, Denmark, from 1996 to 2005. One infant and 34 adults were identified. The incidence of acute epiglottitis in children was 0.02 cases/100,000/year. Before introduction of the H influenzae type b vaccination (1983-1992), the mean national incidence of acute epiglottitis was 4.9 cases/100,000/year. The incidence of acute epiglottitis in adults was constant, with a mean value of 1.9 cases/100,000/year. Twenty-nine per cent of the patients required an artificial airway, and respiratory distress was found to be associated with airway intervention (p = 0.010). All patients recovered completely. In the H influenzae type b vaccine era, acute epiglottitis in children has almost disappeared. The incidence in the adult population has been constant. A discriminate approach to airway management seems safe in adults.