Epiglottitis

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Background

  • Otolaryngologic emergency
    • Can lead to rapid onset of life-threatening airway obstruction
  • Most cases are seen in adults (since advent of H. flu vaccine)
  • Etiology
    • Strep, staph, H. flu (unvaccinated)
    • Caustic burns

Clinical Features

  • Three D's:
    • Drooling
    • Dysphagia
    • Distress
  • Pain with gentle palpation of larynx and upper trachea
  • Stridor
  • Respiratory distress
  • Often no cough seen or noted

Diagnosis

  • Bedside nasopharyngoscopy for direct visualization
  • Imaging only required if diagnosis uncertain
  • Lateral neck x-ray
    • Obliteration of vallecula
    • Edema of prevertebral and retropharyngeal soft tissues
    • "Thumb sign" (enlarged epiglottis)

Treatment

  • Emergent ENT consult
  • O2 (humidified)
  • IVF (hydration minimizes crusting in the airway)
  • Nebulized Epinephrine to reduce edema

Antibiotics

Empiric coverage for Streptococcus pneumoniae, Staphylococcus pyogenes, and Haemophilus influenzae

Steroids

Methylprednisolone 125mg IV

Airway Managment[2]

  • First line therapy is awake fiberoptic with patient sitting up.Intubation
  • Preparation should be made for simultaneous cricothyrotomy incase intubation fails

Disposition

  • Admit with ENT notification

Source

  • Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. Aug 2008;122(8):818-23
  1. Young LS, Price CS. Complicated adult epiglottitis due to methicillin-resistant Staphylococcus aureus. Am J Otolaryngol. Nov-Dec 2007;28(6):441-3.
  2. Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol. Dec 2005;119(12):967-72