Acute epiglottitis is a medical emergency that without prompt treatment may result in death. It results from the inflammation of the supraglotic structures underneath the tongue. Although it is often considered to be a pediatric complaint the actual current occurrence of epiglottitis in adults are in fact 1 to 2 cases per 100,000 people, which is 2.5 times greater than the recorded cases in children. The disease occurs most commonly in those who have not received the Hib, or Haemophilus influenzae type B vaccination. Other common pathogens that may also cause the disease are Streptococcus pneumoniae, Haemophilus parainfluenzae, varicella-zoster, herpes simplex virus type 1, and Staphylococcus aureus. The use of a crack cocaine pipe has also been noted to be a contributing factor in some cases.  The disease occurs most commonly in men over the age of 50 but can occur at any age.

The disease presents itself in adults in a manner somewhat different from that of a child. The most common complaint is a sore throat, a muffled vice and odynophagia. The presence of stridor further increases the need for emergency medical intervention.

In children, with their much narrower airways the emergency management of the airway is almost always necessary, but that is not always the case in adults suffering form epiglottitis. In approximately 80% of adult cases the leukocyte count is found to be 10,000 or greater. Soft tissue neck radiology is fairly accurate when used to make a positive diagnosis of the condition, recognizing about 88% of cases. Those patients who appear to be in severe distress though should not be sent to undergo radiography and direct laryngoscopy should be used to confirm a diagnosis of epiglottitis instead, with the primary focus of treatment being on airway management at all times.

In addition to the constant monitoring of airway function, with or without intubation, the use of intravenous antibiotics is considered the standard treatment, with Cefotaxime, ceftriaxone or ampicillin/sulbactam all being appropriate choices. Steroids are also a common choice amongst clinicians treating the condition.

Teaching Points

1. The condition acute epiglottitus is the result of an inflammation of the supraglottic structures and if not treated promptly and appropriately may result in death. The current rate of occurrence is approximately 1 to 2 cases per 100,000 adults in the US.
2. The chief complaint of those with the affliction is a sore throat, the symptom occurring in about 74-95% of cases. Odynophagia is found to present in as many as 94% of cases.
3. Ther use of soft tissue lateral neck radiography may reveal an enlarged or misshapen epiglottis, commonly known as a “thumbprint sign” and is an accurate diagnostic tool in approximately 88% of cases. A definitive diagnosis however can be made through the use of direct laryngoscopy
4. The accepted treatment of epiglottitus is the administration of intravenous antibiotics in addition to the use of steroids while the patient and their airway function is closely monitored in an ICU setting.