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[Epiglottitis in adults]
M Harell1, E Eviatar, H Flaksman
1Dept. of Otolaryngology, Edith Wolfson Medical Center, Holon.
Insights
Acute epiglottitis, though common in children, is increasingly seen in adults. This study highlights a delayed diagnosis in adult cases, emphasizing the need for prompt recognition and management of this emergency.
Area of Science:
- Otolaryngology
- Emergency Medicine
- Infectious Diseases
Background:
- Acute epiglottitis is a pediatric emergency with decreased mortality due to aggressive treatment.
- Historically considered rare in adults, recent evidence suggests an increasing incidence in the adult population.
- This study focuses on the presentation and management of acute epiglottitis in older patients.
Purpose of the Study:
- To describe the clinical characteristics of acute epiglottitis in a cohort of adult patients.
- To evaluate the diagnostic methods and treatment strategies employed in adult acute epiglottitis.
- To identify potential challenges and outcomes associated with delayed diagnosis in this demographic.
Main Methods:
- Retrospective analysis of 19 adult patients (aged 13-72 years) diagnosed with acute epiglottitis.
- Review of presenting symptoms, time to diagnosis, microbiological findings, and diagnostic imaging (indirect laryngoscopy, lateral neck X-ray).
- Assessment of treatment protocols, including antibiotics, steroids, and airway management, and patient outcomes.
Main Results:
- A significant delay in diagnosis was observed, averaging 2.5 days from symptom onset.
- Common symptoms included severe sore throat and dysphagia; half of the patients experienced respiratory distress.
- Indirect laryngoscopy and lateral neck X-rays were reliable diagnostic tools; conservative management was effective, with only one patient requiring intubation.
Conclusions:
- Acute epiglottitis occurs in adults and is often associated with a delay in diagnosis.
- Prompt recognition of symptoms like severe sore throat and dysphagia is crucial for timely intervention.
- Conservative management, including antibiotics and steroids, is often successful, with a low rate of airway compromise.
Abstract:
Acute epiglottitis in the child is an emergency, well known to pediatricians, that requires rapid diagnosis and treatment. Aggressive treatment in recent years has markedly decreased mortality (17). Acute epiglottitis in adults has been thought to be rare, but lately numerous studies have shown an increase in the disease. We present 19 older patients, aged 13-72 (mean 44.7 years), with acute epiglottitis. A most important finding was the relatively long time from onset of symptoms until diagnosis, averaging 2.5 days. All the blood and throat cultures were negative, except for a single throat culture which yielded Pseudomonas aeruginosa. The most common presenting symptoms were severe sore-throat and dysphagia; half presented with some respiratory distress. Diagnosis was usually made on indirect laryngoscopy, but lateral X-ray of the soft tissues of the neck was found to be highly reliable. Treatment was usually conservative, including antibiotics, rehydration and steroids to alleviate edema. All patients were under strict observation for the first 48 hours, but only 1 required intubation. There were no deaths.