Epiglottic Abscess Research Articles

New Approach in the Management of Adult Epiglottic Abscess—A Case Report

Background: Epiglottic abscess in an otherwise healthy adult is seen as a rare sequelae of acute epiglottitis. It is a life threatening condition which requires emergency management, which if not done early, may result in fatality. Respiratory infections, exposure to environmental chemical or trauma which may lead to inflammation and infection of the structures around the throat which may lead on to epiglottitis, and an epiglottis abscess very rarely. In our case, patient was immediately managed by doing an emergency tracheostomy followed by incision and drainage in the OPD (outpatient department). This emphasizes on need for emergency airway management by doing a tracheostomy there by facilitating incision and drainage in a case of epiglottic abscess as a daycare procedure. Aim: The primary aim of this clinical record is to emphasize the need for immediate airway management in epiglottic abscess there by facilitating incision and drainage as an OPD (out-patient department) Procedure. Case Presentation: A 45-year-old man presented to the OPD (outpatient department) with complaints of dysphagia, odynophagia, muffled voice, noisy breathing for the previous 7 hours. On clinical examination pt was in stridor & respiratory distress. Since the pt was in stridor, it was immediately shifted to the OT (operation theatre), and an emergency tracheostomy was done and the airway was secured, following which a video laryngoscopic examination was done in the OPD, which revealed oedematous enlarged epiglottis with pus pointing obscuring the laryngeal inlet. Abscess was incised and drained, and pus was sent for culture & sensitivity. Pt was treated with I. V (intravenous) antibiotics as per culture reports and subsequent video laryngoscopic examination revealed near normal epiglottis with an adequate laryngeal inlet. Conclusion: Patients with epiglottic abscess are at increased risk of airway compromise, hence in such patients airway should be immediately secured by doing an emergency tracheostomy. This case shows the benefits of an emergency tracheostomy for doing incision and drainage for epiglottic abscess as an OPD procedure.

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.

Asphyxia death caused by epiglottic abscess rupture in an adult: A case report

Asphyxia death caused by epiglottic abscess rupture in an adult: A case report

An unusual case of acute epiglottic abscess.

A 48 year old man presented to our outpatient department with the history of absolute dysphagia, and fever for two days. On examination patient was febrile with drooling of saliva. Oropharynx was minimally congested. Indirect laryngoscopy revealed odematous epiglottis with pus pointing over the lingual surface. Radiography of soft tissue, neck lateral view, showed the thumb sign which suggested epiglottitis. Incision and drainage was performed under general anaesthesia after haematological investigations. Patient was extubated the next day, and was discharged after two days, also oral antibiotics, and analgesics were prescribed. Patient was reviewed after 2 weeks, and indirect laryngoscopy revealed a normal epiglottis.Although pharyngitis is the most common cause of sore throat in adults, acute epiglottitis must be considered in differential diagnosis when there is unrelenting throat pain, and minimal objective signs of pharyngitis. Epiglottic abscess formation is more common in adults than children. They most commonly occur as a complication of acute pharyngitis or with abscess of lingual tonsil .The abscess most frequently comes to a point on or near the lingual surface of the epiglottis. Streptococcus was isolated more frequently. Other organisms reported were Haemophilus influenzae, E.coli, Pseudomonas, Micro- coccus catarrhalis, Pneumococci. In our case, there were no preceding symptoms of acute pharyngitis. Risk factors include adult age at onset, diabetes mellitus, trauma, presence of a foreign body, and immune- compromised state. This case is unusual because of the absence of above risk factors. Incision and drainage under general anaesthesia is the treatment of choice. To the author’s knowledge, very few cases of acute epiglottic abscesses have been reported in the literature. This case is unusual because there are no preceding symptoms of pharyngitis or tonsillitis, and no association of risk factors like diabetes mellitus, trauma, foreign body or immunocompromised state.

喉頭蓋膿瘍8例における診断と気管切開，膿瘍ドレナージの必要性についての検討

喉頭蓋膿瘍は急性喉頭蓋炎が重篤化した病態と報告されており，気道確保と膿瘍のドレナージの必要性について検討しなければならない。今回われわれは，喉頭蓋膿瘍の8例についてドレナージの必要性と，同時期に入院加療を行った急性喉頭蓋炎19例と比較して，診断と気管切開の検討を行った。喉頭ファイバーで喉頭蓋の左右非対称，黄色調変化，緊満感に加えて表面の不整形を認める場合は，喉頭蓋膿瘍を疑い頸部造影CTを追加して診断する必要がある。気管切開を行う指標としては，呼吸困難感やStridorなど呼吸症状を認める，喉頭蓋腫脹が高度で披裂部腫脹がある，症状出現から24時間以内に呼吸困難が生じている，喉頭蓋膿瘍で特にKatori分類でB群を伴っているものがあげられる。また，喉頭蓋膿瘍で気管切開術を行う症例では重症化予防・入院日数軽減のため，ドレナージの追加を検討する必要がある。

Routine computerised tomography in patients with acute supraglottitis for the diagnosis of epiglottic abscess: is it necessary? – a prospective, multicentre study

To evaluate the predictive factor of epiglottic abscess and to investigate whether routine computerised tomography (CT) in patients with acute supraglottitis are necessary. A prospective and multicentre study. Tertiary care referral medical centre. A total of 202 patients with suspected acute supraglottitis were enrolled. All patients underwent CT to confirm the presence of abscess. The patients' characteristics, symptoms at presentation, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification and initial laboratory finding were analysed. Of 202 patients, 158 (78%) had acute supraglottitis and 44 (22%) had epiglottic abscess. There was no significant difference in age between the acute supraglottitis group and the epiglottic abscess group. Men were significantly more frequent in the epiglottic abscess group than females (P=0.042). When comparing the symptom at presentation, the patients with epiglottic abscess complained of voice change more frequently (P=0.003). Moderate or severe epiglottic swelling in scope classification was significantly associated with epiglottic abscess (P<0.001). In logistic regression analysis, voice change [OR=2.64, 95% CI=1.29-5.40, P=0.008] and moderate or severe epiglottic swelling in laryngoscopic findings [OR=3.94, 95% CI=1.63-9.53, P=0.002] were independent predictive factors for epiglottic abscess. The positive predictive values of voice change and moderate or severe epiglottic swelling were 33% and 30%, respectively. The negative predictive values of voice change and moderate or severe epiglottic swelling were 15% and 9%, respectively. Routine CT might be suggested for diagnosis of epiglottic abscess in the patients with acute supraglottitis, because of the poor predictive values of symptoms and signs.

Epiglottic abscess as a complication of acute epiglottitis

ObjectiveAn epiglottic abscess is considered a life-threatening medical situation that can cause death by obstruction the upper airways. We describe a 58-year-old man who presented to our hospital with sore throat, dysphagia and dysphonia. Materials and methodsA fiberoptic laryngoscope (FOL) demonstrated beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. CT scan showed multiple air bubbles inside the swollen epiglottis, in keeping with the diagnosis of necrotizing epiglottic abscess. ResultsUnder local anesthesia we performed puncture of the abscess at the tip of the epiglottis. He was dismissed 5days from his admission to the hospital after an improvement was noticed in his epiglottis. ConclusionTreatment consists of airway management if needed under anesthesia and draining of the abscess. An IV antibiotics plus corticosteroids should be administrated the moment a suspicion of epiglottitis is present.

Fatal Epiglottic Abscess After Radiotherapy for Laryngeal Carcinoma

Acute epiglottitis is a rare condition, especially in adults, largely owing to the widespread vaccination against Haemophilus influenzae. Traumatic epiglottitis as a result of thermal or caustic insults is documented. Epiglottic abscess formation is described as a sequela of epiglottitis in some cases. The development of epiglottic abscess from epiglottitis secondary to radiotherapy has previously been described in the literature; however, there are no reports of fatalities due to epiglottic abscess after radiotherapy. We present an unusual case of an adult sudden death due to epiglottic abscess formation subsequent to radiotherapy for laryngeal squamous cell carcinoma.

Adult Epiglottic Abscess: A Case Report

A case of epiglottic abscess in an otherwise healthy adult male is reported. Patient was initially managed as acute epiglottis with parenteral antibiotics, humidified air, and steroids close ICU monitoring. Failure of recovery and re-evaluation revealed an abscess of epiglottis. Management with intubation and incision and drainage of abscess lead to very rapid recovery and subsequent discharge of patient.

Fatal epiglottic abscess following radiotherapy for laryngeal carcinoma

Acute epiglottitis is a rare condition, especially in adults, largely due to widespread vaccination against Haemophilus influenzae. Traumatic epiglottitis as a result of thermal or caustic insults are well documented. Epiglottic abscess formation is described as a sequela of epiglottitis in some cases. The development of epiglottic abscess from epiglottitis secondary to radiotherapy has not previously been described in the literature. We present an unusual case of an adult sudden death due to epiglottic abscess formation subsequent to radiotherapy for laryngeal squamous cell carcinoma. Acute epiglottitis is a rare condition, especially in adults, largely due to widespread vaccination against Haemophilus influenzae. Traumatic epiglottitis as a result of thermal or caustic insults are well documented. Epiglottic abscess formation is described as a sequela of epiglottitis in some cases. The development of epiglottic abscess from epiglottitis secondary to radiotherapy has not previously been described in the literature. We present an unusual case of an adult sudden death due to epiglottic abscess formation subsequent to radiotherapy for laryngeal squamous cell carcinoma.

急性喉頭蓋炎４３例の検討

We retrospectively reviewed medical records of all those admitted and diagnosed with acute epiglottitis from 2006 to 2009. Of these 43—26 men and 17 women—9 underwent tracheotomy. Epiglottal and arytenoidal swelling severity were classified based on the classification of Katori et al. Focusing on epiglottal swelling seen under flexible laryngoscopy, we divided subject types into abscess and edema, and studied how these classifications and tracheotomy indications were related. The percentage of tracheotomy was 42.9% for severe epiglottal swelling, 7.7% for moderate swelling and 12.5% for mild swelling. Tracheostomy was also done in 36.8% with arytenoidal swelling and 8.3% with non arytenoidal swelling, 36.8% with epiglottic abscess and 8.3% without abscess. Epiglottal abscess formation was thus a risk factor strongly associated with airway intervention as well as severe epiglottal and arytenoidal swelling.

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.

Epiglottic Abscess in an HIV-Positive Patient

Coalescence of infection of the epiglottis, or epiglottic abscess, is a rare manifestation of epiglottitis. We report the case of a 49-year-old Hispanic man with HIV (CD4 count 243 [16.2%]), HIV viral load 175,689 copies per milliliter, antiretroviral-naive) contracted from his wife who presented to the emergency department with a 3-week history of sore throat, odynophagia, left temporal headache, left neck pain, and occasional blood-streaked sputum. This case represents the first reported case of epiglottic abscess in an HIV-positive individual. Epiglottic abscess formation is associated with potentially rapid airway compromise and carries a high mortality rate. The diagnosis of epiglottic abscess is often difficult. In HIV-infected individuals, a variety of infectious and oncologic sources of respiratory compromise should be considered in addition to epiglottic abscesses. Prompt diagnosis and treatment of this condition is crucial for ensuring optimal outcomes in this rare but often lethal infection.

Efficacy of spinal needle aspiration for epiglottic abscess in 90 patients with acute epiglottitis

Conclusion. Patients with epiglottic abscesses showed more severe symptoms than those with acute epiglottitis and were at increased risk of airway compromise. All 11 patients with epiglottic abscesses underwent spinal needle aspiration; all were cured without severe complications. These findings indicate that spinal needle aspiration is both safe and effective in patients with epiglottic abscesses. Objectives. Acute epiglottitis is a disease that may become serious or even fatal because of sudden upper airway obstruction. An epiglottic abscess may result from a coalescent epiglottic infection due to acute epiglottitis or secondary infection of an epiglottic mucocele. There have been few reports comparing acute epiglottitis with epiglottic abscess. We therefore assessed the clinical characteristics of each condition, as well as the efficacy of spinal needle aspiration and drainage of epiglottic abscesses. Patients and methods. We retrospectively reviewed the records of 90 hospitalized patients diagnosed with acute epiglottitis and epiglottic abscess by flexible nasopharyngolaryngoscopy between March 2006 and February 2008. All patients were treated with medication; in addition, those with epiglottic abscess underwent spinal needle aspiration. Results. Of 90 patients, 79 had acute epiglottitis and 11 had epiglottic abscesses. Acute epiglottitis was most common in May (16.5%) and epiglottic abscesses were most common in June (27.3%). The most common symptoms were sore throat (91.1%), dysphagia (38.9%), voice change (33.3%), and dyspnea (16.7%). All patients were treated with antibiotics and steroids. The mean length of hospitalization was 5 days. No patient required a tracheostomy or orotracheal intubation.

Acute epiglottic abscess in an adult.

A case of acute epiglottic abscess is reported in an adult female patient who presented with odynophagia and fever. Initial treatment with parenteral antibiotics was not much of a success until incision and drainage of abscess was carried out under general anaesthesia after securing airway with preliminary tracheostomy. Diagnostic difficulties due to different mode of presentation in adults are emphasized. The diagnostic workup and treatment options are discussed.

喉頭蓋膿瘍５例の検討

Severe airway stenosis due to acute upper airway infection is an emergent situation. Without prompt and appropriate treatment, the outcome may be fatal.During the period from November 2005 to October 2006, we treated five epiglottic abscess patients. We examined the occurrence factors and their clinical courses. We divided these patients into two groups regarding their postoperative clinical courses in order to examine the retrospective necessity of tracheostomy.One case had diabetes and chronic renal failure, but the other four had no past illness which might reduce immune function. We experienced two cases who showed advanced epiglottic abscess in spite of conservative therapy against epiglottitis.We performed surgical drainage and tracheostomy in all five patients. Although upper airway stenosis improved satisfactorily after operations in two of the five (group I), epiglottic swelling was exacerbated again on the day following the operation compared with the epiglottic thickness immediately after the operation in the other three (group II). We investigated clinical differences between the two groups, and found that both the value of CRP and number of WBC in group II on the day when abscess diagnosis was made had a tendency to be higher compared with those in group I. And the number of hospitalization days of group II also had a tendency to be longer than that of group I.Epiglottic abscess runs a risk of suffocation. In contrast, patients generally convalesce satisfactorily with appropriate airway management. Accurate diagnosis and prompt treatment are thought to be essential.

急性喉頭蓋炎・喉頭蓋膿瘍症例における中咽頭所見の検討

Episodes of acute epiglottitis in 18 patients, including 6 cases with epiglottic abscess were analyzed retrospectively.None of the acute epiglottitis cases had airway obstructions that necessitated airway management. With the epiglottic abscess cases, however, tracheal intubations or tracheostomies were performed. Cultures retrieved from the abscess cavities revealed normal pharyngeal flora and anaerophytes.Except for one case, all cases with epiglottic abscesses were accompanied by inflammation at the inferior pole of palatine tonsil. Pharyngeal inflammation was seen in all cases of epiglottitis with bilateral arythenoid swelling. Acute epiglottitis with pharyngeal inflammation seems to have a high risk of progressive upper airway obstruction.

Epiglottic Abscess during Cyclosporine Therapy for Prurigo

Cyclosporine is an immunosuppressant that suppresses cell-mediated immunity; it is used not only in organ transplantation to prevent rejection, but also outside of transplantation such as for nephrotic syndrome and severe inflammatory diseases. Infection induced by immunosuppressants is well known, and the incidence of infection related to immunosuppressants is rising with their increasing use for various diseases. We describe a patient with an epiglottic abscess who had been taking cyclosporine 4mg/kg/day for prurigo. Because antibiotics and steroid therapy were not usable, we performed surgical drainage of the epiglottic abscess under infrapsychic nasotrachial intubation.

The rising incidence of adult acute epiglottitis and epiglottic abscess

Objective To examine preliminary observations that the incidence of adult acute epiglottitis has risen between 1986 and 2000. Materials and methods Demographics, annual and seasonal occurrences, clinical presentation, diagnostic procedures, treatment, airway management, and complications of 116 consecutive adult patients with laryngoscopically confirmed acute epiglottitis are presented. Results The mean annual incidence of acute epiglottitis per 100,000 adults significantly increased from 0.88 (from 1986–1990) to 2.1 (from 1991–1995) and to 3.1 (from 1996–2000) ( P < .001). This rise seems to be unrelated to Haemophilus influenzae type b infection but related to miscellaneous pathogenic bacteria. During these periods, the number of epiglottic abscesses increased concomitantly with the rise in the incidence of acute epiglottitis (from 4/14 episodes [29%], to 8/38 [21%], and to 16/66 [24%], respectively), showing a relatively constant ratio between both phenomena ( P = .843). Twenty-five patients (21%) underwent airway intervention, 16 because of objective respiratory distress and 9 because of imminent respiratory obstruction. Stepwise logistic regression showed that drooling, diabetes mellitus, rapid onset of symptoms, and abscess formation were associated with airway obstruction. Diverse origins for the epiglottic abscess, either from coalescent epiglottic infection or from mucopyocele of the tongue base, are suggested. Conclusions A rise in the incidence of acute epiglottitis and a concomitant rise in the number of epiglottic abscesses were established. Although the course of acute epiglottitis is often benign and can be safely treated with a conservative management approach, delayed airway obstruction may develop from a few hours to days after admission.

Need for Tracheotomy is Rare in Patients with Acute Supraglottitis: Findings of a Retrospective Study

We retrospectively reviewed the cases of 23 adults and six children who had been given a presumed diagnosis of acute supraglottitis between 1987 and 1997. The most common symptoms in these patients were odynophagia, dysphagia, hoarseness, and fever. Stridor and drooling were also observed, primarily in the children. Fiberoptic laryngoscopy confirmed the presence of edema and erythema of the supraglottic structures in all patients. Blood cultures were positive for Hemophilus influenzae type b in three children and for Serratia marcescens in one adult. All other blood cultures were negative. All patients were treated with intravenous broad-spectrum antibiotics and humidified oxygen, and two-thirds received intravenous corticosteroids. Patients were monitored with pulse oximetry and serial fiberoptic laryngoscopy. Two patients required intubation; one had an epiglottic abscess, and the other had laryngeal edema so severe that vocal fold mobility could not be assessed. The length of stay in the intensive care unit ranged from 1 to 7 days (mean: 1.9). All patients recovered and were discharged free of symptoms after 2 to 11 days of overall hospitalization (mean: 4.4).