January 4, 2012 by dailybolusoflr
Acute Epiglottitis in Adults
Epiglottitis in adults is a similar and yet distinct entity to that which is found in children.
While children classically had the etiologic organism as H.flu type B, with the advent of widespread vaccination, the incidence of epiglottitis in children has decreased. This is in clear contrast to adults, in which the incidence of epiglottis has increased over the recent years. Adults often have no identifiable organism found as the etiology of the epiglottis but the process can be caused by H.flu, strep, staph, pneumoccocus and many other organisms.
Adults tend to have more of a diffuse inflammatory process with most of the supraglottic structures becoming inflamed and edematous.
Adults also have a higher mortality as they tend to present later, are less likely to have stridor (larger airways) and are more likely to have the diagnosis missed.
Patients will most commonly present with a complaint of a sore throat, trouble swallowing and possibly trouble breathing. Other concerning findings can include: fever, drooling, trismus, soft tissue edema of the neck.
Adult disease can progress extremely rapidly and even a patient who appears non-stridorous can progress to complete airway obstruction within a matter of minutes to hours.
Lateral soft tissue X-rays can be obtained to look for the “thumb print sign” but if neg, do not rule out the disease.
Certainly patients who are unstable should not be moved to radiology and should not be made to lay down for imaging, which can compromise their airway.
Treatment can include:
* Antibiotics (3rd generation cephalosporin is typical)
* Steroids (unclear benefit in the literature)
* Nebulized epinephrine
* Protected location for evaluation of the airway (fiberoptic nasal approach is preferred) – best is in the OR
* Avoidance of direct laryngoscopy, if possible, as further can inflame the area
* Preparation for rescue methods such as cricothyrotomy and/or definitive tracheostomy