Acute epiglottitis in adults: diagnosis and treatment in 43 patients

Epiglottitis (supraglottitis) is an acute infection involving the supraglottic larynx that usually occurs in children, but can also affect adult patients. The purpose of this study was to retrospectively analyze diagnostic and treatment methods in adults with epiglottitis seen over a 10-year period at the Winnipeg Health Sciences Centre. Forty-three epiglottitis patients over the age of 16 were treated between 1982 and 1992. Treatment was individualized according to airway status at presentation, and not based on clinical staging protocols. A total of 29 patients were treated conservatively, whereas 14 patients were intubated immediately. One expectantly managed patient had to be intubated on the ward, and one patient died from septicemia. No presenting symptom or sign reliably predicted the need for intubation. Epiglottitis is seen in adults and can be easily and safely diagnosed by either indirect or flexible laryngoscopy. Endotracheal intubation is the safest and most direct means of securing the airway in severely affected patients. Staging systems are useful for retrospective data analysis, but should not be relied on to predict the course of patients with an inherently unpredictable disease.