Due to the advent of the Hib vaccine in the 1980’s, the presentation of epiglottitis in the pediatric population has drastically decreased, while the rare presentation of the adult has stayed consistent. [openanesthesia.org]

Of the 40 children presenting with epiglottitis, eight (20%) presented after the introduction of the Hib conjugate vaccine. [ncbi.nlm.nih.gov]

• Fever

  She presented with high fever, arthralgia, general fatigue and strong throat pain. Laryngeal fiberscopy showed a markedly swollen epiglottis suggestive of acute epiglottitis, though she had no signs of asphyxia. [ncbi.nlm.nih.gov]

  Images in Clinical Medicine Casey Grover, M.D. 4 Citing Articles A 58-year-old man presented to the emergency department after having had severe throat pain, hoarseness, and fever for 2 days. [nejm.org]

• Pediatric Disease

  Before the widespread use of its conjugated immunization, Haemophilus influenza type b was the most common cause and it was usually thought of as a pediatric disease process. [pediatriceducation.org]

• Malaise

  Symptoms usually progress slowly and may be associated with chest pain, neck pain, fatigue, malaise, unexplained fever, or weight loss. [ahcmedia.com]

  Symptoms of sore throat from either a viral or bacterial infection can be generalized symptoms that occur throughout the body such as fever, headache, nausea, and malaise. [emedicinehealth.com]

• Stridor

  The incidences of drooling, stridor/dyspnea, and muffled voice were significantly higher in the airway-supported group ( P < 0.05). Stridor/dyspnea is a reliable clinical predictor of airway compromise (odds ratio 2.94; P = 0.0277). [ncbi.nlm.nih.gov]

  Stridor, as well as sore throat with a normal-appearing pharynx, are important clues. Examination of the pharynx or larynx in children with epiglottitis and stridor may precipitate complete airway obstruction. [merckmanuals.com]

  Red flags Stridor is a late sign - do not discount patients who are not stridulous. Act on clinical suspicion based on the history. Once stridor develops, you may only have minutes to act. [entsho.com]

  A physical examination revealed no stridor, respiratory distress, or drooling. The results of an oropharyngeal examination were unremarkable. [nejm.org]

• Cough

  Case A 2 year old girl presents to the emergency room with fever, cough, runny nose, stridor and difficulty breathing. Temperature is 101, RR 30, there is audible stridor and a barky cough (click on barky cough). [pedclerk.bsd.uchicago.edu]

  This is a 20 month old male who presents to the emergency department with a chief complaint of cough. Two days ago he developed rhinorrhea, fever, a hoarse cry and a progressively worsening, harsh, "barky," cough. [hawaii.edu]

  Cover your mouth when you sneeze or cough. Wash your hands after you cough, sneeze, or use the bathroom. Ask your healthcare provider if other family or household members need antibiotic medicine to prevent infection. [drugs.com]

  The typical presentation of acute epiglottitis in a child is a 2-6 year old with severe sore throat, dysphagia, and a muffled voice without cough or rhinorrhea. [openanesthesia.org]

• Hoarseness

  Other important clinical factors to consider are odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis and a high WBC count. [ncbi.nlm.nih.gov]

  Images in Clinical Medicine Casey Grover, M.D. 4 Citing Articles A 58-year-old man presented to the emergency department after having had severe throat pain, hoarseness, and fever for 2 days. [nejm.org]

  Sore throat and hoarseness, frequently with a high fever, develop abruptly in a previously well individual. [medicinenet.com]

• Inspiratory Stridor

  Additionally, airway patency should be established when inspiratory stridor appears assuring uncomplicated recovery. [ncbi.nlm.nih.gov]

  Symptoms include severe sore throat, dysphagia, high fever, drooling, and inspiratory stridor. Diagnosis requires direct visualization of the supraglottic structures, which is not to be done until full respiratory support is available. [merckmanuals.com]

  In more severe cases, the patient may present in a sitting, or tripod, position in effort to alleviate upper airway obstruction as well as with inspiratory stridor. [openanesthesia.org]

• Aspiration

  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. [ncbi.nlm.nih.gov]

  • Non-infectious diseases Allergic reactions, angioneurotic oedema, foreign body aspiration, reflex laryngospasm, laryngeal trauma, tumours, hydrocarbon aspiration, systemic lupus erythematosis and inhalation of toxic fumes or superheated steam 13. [slideshare.net]

  Other conditions that have a similar presentation include angioedema, foreign-body aspiration, and retropharyngeal or peritonsillar abscesses. [internalmedicinejournal.blogspot.com]

  Efficacy of Spinal Needle Aspiration in Patients with Epiglottic Abscess: A Prospective, Randomized, Controlled Study. Otolaryngol Head Neck Surg. 2015 Jul. 153 (1):48-53. [Medline]. Wu Y, Yang C, Xi H, Zhang Y, Zhou Z, Hu Y. [emedicine.com]

• Odynophagia

  Other important clinical factors to consider are odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis and a high WBC count. [ncbi.nlm.nih.gov]

  Acute epiglottitis should be suspected in all patients with a history of sore throat and odynophagia, especially if symptoms are out of proportion to pharyngel findings. [arquivosdeorl.org.br]

  Diagnosis in adults may be delayed a sore throat and odynophagia are the only complaints and they do not have signs and symptoms of airway obstruction. [waent.org]

• Gagging

  In our case, oral local anesthetic spray did not completely abolish gag reflexes and pain. Gag reflex, due to moderate discomfort during fiberoptic intubation, traumatized the pharynx but fortunately left the abscess intact [Figure 3]. [joacp.org]

  Indirect laryngoscopy should be done with caution since patient gagging may worsen or participate catastrophic airway obstruction. [waent.org]

Workup Airway management is the most urgent consideration, and patients should first be assessed for level of distress before any other workup. [emedicine.com]

• Subglottic Narrowing

  narrowing and ballooning of hypopharynx no epiglottis thickening inhaled foreign bodies pharyngitis pneumonia peritonsillar abscess retropharyngeal abscess usually clinical following tonsillitis bacterial tracheitis asymmetric subglottic narrowing (intraluminal [radiopaedia.org]

  narrowing (steeple sign) and a normal-sized epiglottis *Also called viral laryngotracheal bronchitis. [merckmanuals.com]

  Chest radiographs may show subglottic narrowing (in 50% of children with croup), but this can also be seen in normal patients. [hawaii.edu]

  Weppner, DO Figure 4: CT Scan of the Neck Revealing Swelling Epiglottis and Aryepiglottic Folds with Significant Subglottic Narrowing From the collection of Justin L. [ahcmedia.com]

The purpose of this study was to retrospectively analyze diagnostic and treatment methods in adults with epiglottitis seen over a 10-year period at the Winnipeg Health Sciences Centre. [ncbi.nlm.nih.gov]

The primary element in treatment is the maintenance of an adequate airway, including tracheostomy when indicated. Prompt, aggressive antibiotic treatment is indicated after suitable cultures are obtained. [annals.org]

Prognosis: • The prognosis in adults with acute epiglottitis is good with appropriate and timely treatment. • Most patients can be extubated within several days. • However, unrecognized epiglottitis may rapidly lead to airway compromise and resultant [slideshare.net]

In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention. [ncbi.nlm.nih.gov]

Prognosis The prognosis in adults with acute epiglottitis is good with appropriate and timely treatment. Most patients can be extubated within several days. [emedicine.com]

Among the 158 cases, the infectious etiology was identified in 29 (H. influenzae 20, Streptococcus pneumoniae six, H. parainfluenzae two, Streptococcus pyogenes one). In the remaining cases, the etiology was uncertain. [ncbi.nlm.nih.gov]

When an etiologic agent is identified, it is usually Hemophilus influenzae. [shmabstracts.com]

There also appears to be a 60% male predominance, which has remained true even with the changing epidemiology of epiglottitis. Epiglottitis was once believed to occur exclusively in children. [emedicine.medscape.com]

CONCLUSIONS: There have been significant changes in the clinical epidemiology of epiglottitis, which now occurs almost exclusively in adults, often with less severe symptoms and a lower incidence of H influenzae infection. [ncbi.nlm.nih.gov]

After the third recurrence, careful consideration was given to possible pathophysiologic mechanisms and potential therapeutic options. Further recurrence was prevented effectively by performing a lingual tonsillectomy. [ncbi.nlm.nih.gov]

Risk factors in adults include hypertension, diabetes mellitus, substance abuse, immune deficiency, and airway trauma. return to top Pathophysiology Infectious epiglottitis results from bacteremia or from direct spread to the epithelial layer of the epiglottis [sharinginhealth.ca]

It is important for anaesthetists and intensive care specialists to be able to manage upper airway obstruction resulting from acute epiglottitis and have a clear understanding of the aetiology and the pathophysiology of this condition. [ispub.com]

Pathophysiology, evaluation and treatment of the difficult airway. Anesth Clin North Am 1998;16:29-75. 6. Muller BJ, Fliegel JE. Acute epiglottitis in a 79-year-old man. Can Anaesth Soc J 1985;32:415-7. [ PUBMED ] [Figure 1], [Figure 2], [Figure 3] [joacp.org]

[…] also been described in an adult receiving infliximab, prednisone, and azathioprine for Crohn’s disease. 47 Noninfectious causes of epiglottitis should also be considered, including thermal injury, foreign body ingestion, and caustic ingestion. 48-50 Pathophysiology [ahcmedia.com]

Lingual tonsillectomy in these cases may help prevent further recurrent episodes. [ncbi.nlm.nih.gov]