Acute epiglottitis in adults: an under-recognized and life-threatening condition

Epiglottitis is a potentially life-threatening condition resulting from infection of the epiglottis and surrounding structures, causing classical signs and symptoms related to inflammation and progressive airway obstruction. We briefly present two recent adult cases of epiglottitis, followed by a review of the literature concerning the subject. In diagnosing epiglottitis, direct visualization by laryngoscopy is the gold standard. Lateral neck X-rays also have great utility, but with less sensitivity than direct visualization. Though historically more of a burden for the pediatric population, epiglottitis does occur in adults, often with a milder clinical course. And while aggressive treatment in the pediatric population has driven mortality from 7 percent to about 1 percent, mortality in the adult population remains at about 7 percent. Some debate exists over how aggressively to approach the adult with epiglottitis due to the more variable nature of presentation in the adult population. Though prophylactic airway management is not necessarily indicated in the adult with epiglottitis, careful attention to the airway in a controlled intensive care environment is recommended. The severity of the clinical picture should guide the physician in his or her approach. Any clinical suspicion of epiglottitis warrants an aggressive approach until epiglottitis is ruled out or the patient is recovering well.