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Epiglottitis — Clinical Guidelines

Overview

Epiglottitis is a potentially life-threatening inflammatory condition affecting the epiglottis, often caused by bacterial infection, leading to airway obstruction and respiratory distress 1 5 10.

Diagnosis

Clinical Presentation: Sudden onset of sore throat, fever, dysphagia, and signs of airway distress 1 5.

Physical Examination: Look for muffled voice (hot potato voice), drooling, and stridor 1 5.

Imaging: CT scan is crucial for confirming diagnosis, especially in identifying abscesses or extent of swelling 1 4 6.

Laryngoscopy: Flexible nasolaryngoscopy can visualize epiglottitis; avoid rigid laryngoscopy in unstable patients 1 5.

Management

Antibiotics: Broad-spectrum coverage, often including cefotaxime and metronidazole 5.

Steroids: High-dose corticosteroids to reduce airway swelling 1 5.

Airway Management: Intubation for airway obstruction exceeding 50% obstruction 5.

Monitoring: Continuous monitoring of airway patency and respiratory status 1 5.

Special Populations

Pediatrics: Higher incidence of extraepiglottic infections like pneumonia and cervical lymphadenitis (25% incidence noted) 9.

Adults with Comorbidities: Increased vigilance required, especially in those with concurrent tonsillitis or peritonsillar abscess 1 4 5.

Key Recommendations

Immediate Imaging: Obtain CT scan in stable patients with suspected epiglottitis to rule out abscesses and guide treatment 4 (Evidence: Moderate).

Airway Intervention: Perform intubation for patients with significant airway obstruction (>50% obstruction) 5 (Evidence: Moderate).

Antibiotic Therapy: Initiate broad-spectrum antibiotics, including coverage for anaerobes, in all cases 5 (Evidence: Moderate).

Steroids for Swelling: Administer high-dose corticosteroids to manage airway swelling 1 5 (Evidence: Moderate).

Monitor for Complications: Watch for signs of extraepiglottic infections, particularly in pediatric patients 9 (Evidence: Moderate).

References

1 Parthasarathy V, Snyder B, Saddawi-Konefka R. A Lot to Choke on: Case of Adult Epiglottitis with Concurrent Peritonsillar Abscess in a Patient with a Sore Throat. The Journal of emergency medicine 2018. link 2 Kim YJ, Myung NS, Lee HJ, Koo SK. A case of congenital aplasia of the epiglottis in an adult. American journal of otolaryngology 2014. link 3 Lacourt M, Marcoux M. Treatment of epiglottic entrapment by transnasal axial division in standing sedated horses using a shielded hook bistoury. Veterinary surgery : VS 2011. link 4 Ito K, Chitose H, Koganemaru M. Four cases of acute epiglottitis with a peritonsillar abscess. Auris, nasus, larynx 2011. link 5 Hafidh MA, Sheahan P, Keogh I, Walsh RM. Acute epiglottitis in adults: a recent experience with 10 cases. The Journal of laryngology and otology 2006. link 6 Ozanne A, Marsot-Dupuch K, Ducreux D, Meyer B, Lasjaunias P. Acute epiglottitis: MRI. Neuroradiology 2004. link 7 Wurtele P. Acute epiglottitis: historical highlights and perspectives for future research. The Journal of otolaryngology 1992. link 8 Navarrete ML, Quesada P, Garcia M, Lorente J. Acute epiglottitis in the adult. The Journal of laryngology and otology 1991. link 9 Molteni RA. Epiglottitis: incidence of extraepiglottic infection: report of 72 cases and review of the literature. Pediatrics 1976. link 10 Addy MG, Ellis PD, Turk DC. Haemophilus epiglottitis: nine recent cases in Oxford. British medical journal 1972. link

Epiglottitis