Epiglottitis at the extremes of age

Area of Science:

• Pediatrics
• Emergency Medicine
• Otolaryngology

Background:

• Epiglottitis typically presents predictably in children and young adults.
• Clinical presentation in infants and elderly adults remains less characterized.
• Understanding atypical presentations is vital for timely diagnosis and treatment.

Purpose of the Study:

• To characterize the clinical presentation of epiglottitis in patients at the extremes of age (infants ≤24 months and adults ≥50 years).
• To compare these presentations with the classic epiglottitis profile.
• To evaluate diagnostic and management appropriateness in the emergency department.

Main Methods:

• Retrospective review of epiglottitis cases in an emergency department from 1974-1984 (infants) and 1979-1984 (adults).
• Analysis of presenting symptoms, duration, and specific clinical signs in both age groups.
• Comparison of observed symptoms against established epiglottitis criteria.

Main Results:

• Infants (≤24 months): Less than half showed rapid respiratory/swallowing/vocalization issues; prolonged parental delay in seeking care was common. Respiratory symptoms like cough and tachypnea were frequent, but drooling was rare.
• Adults (≥50 years): Symptoms spanned days; severe sore throat, muffled voice, and fever were uncommon. Dysphagia and mild respiratory issues were frequent.
• Both groups exhibited frequent deviations from the classic epiglottitis presentation.

Conclusions:

• Epiglottitis in infants and the elderly frequently presents atypically, challenging classic diagnostic patterns.
• Despite variations, emergency department diagnosis and management were generally appropriate.
• Awareness of these diverse presentations is essential for effective clinical practice in extreme age groups.