Early intervention of transoral laser-assisted marsupialization for adult epiglottic abscess.

Epiglottic abscess is a potentially fatal disease by airway compromise. Emergent airway intervention and admission to an intensive care unit are frequently required for patients with epiglottic abscess. Epiglottic abscess also doubles the duration of hospitalization compared to non-abscess epiglottitis. Abscess drainage, antibiotics administration, and airway monitoring are the mainstays of treatment. Spinal needle aspiration has been introduced to treat epiglottic abscess, which shows no significant additional benefit from a comparative study. Marsupialization has been commonly utilized to treat benign cystic diseases. Early surgical intervention of epiglottic abscess may resolve patient symptoms and secure the airway. Early intervention of transoral laser-assisted marsupialization for epiglottic abscess was a safe, simple, and reliable technique that guaranteed early recovery in 12 cases. Therefore, this article presents the procedures, pros, and cons of this method for treating epiglottic abscess.

Use of Indirect Laryngeal Biopsy Forceps to Treat Epiglottic Abscess.

OBJECTIVES: To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA). METHODS: Twenty patients were diagnosed with EA in our department and were randomly divided into group A (indirect laryngeal biopsy forceps combined antibiotics) and group B (antibiotics only). Demographics, the degree of epiglottic and arytenoid swelling, and inflammatory cells were collected for analysis. The drainage of EA was performed under local anesthesia in conscious patients with indirect laryngeal biopsy forceps and 70° direct laryngoscopes. The length of symptomatic relief and length of hospitalization were assessed. RESULTS: Ten patients were treated with indirect laryngeal biopsy forceps under the view of the 70° direct laryngoscopes combined with intravenous antibiotics, whereas the other 10 patients were treated with antibiotics only. The differences between the 2 groups had no statistical significance in age, gender, white blood cell count, neutrophils count, and the percent of neutrophils, abscess size, and scope classification at the time of diagnosis. The length of hospitalization and length of symptomatic relief was significantly lower in patients treated with indirect laryngeal biopsy forceps combined antibiotics than those treated with antibiotics only. CONCLUSIONS: Indirect laryngeal biopsy forceps are safe and effective method to treat EA, which shorten the hospitalization and has the advantages of cost savings and convenience.

Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis.

PURPOSE: In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do. METHODS: We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed. RESULTS: The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p < 0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 € and 5.856 € in the intubated and tracheotomized patient groups, respectively (p < 0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097). CONCLUSION: Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients. LEVEL OF EVIDENCE: 2b.

[Anesthetic management using veno-veno bypass for emergent tracheostomy in a patient with acute epiglottitis].

We report anesthetic management using veno-veno bypass (V-V bypass) for emergent tracheostomy in a patient with acute epiglottitis. A 72-year-old woman complained of dyspnea due to acute epiglottitis, and emergent tracheostomy was planned for her. Since physical and optical fiberscopic examinations indicated a high risk of airway collapse during anesthetic induction, we planned to do tracheostomy under V-V bypass in order to maintain oxygenation. V-V bypass was established using the right femoral and jugular veins in an awake condition. After starting V-V bypass, tracheostomy was performed under intravenous propofol anesthesia. During surgery, bispectral index was maintained below 60. Surgery was carried out with ease and uneventfully. The patient had no complications due to V-V bypass postoperatively.

[Sudden cardiorespiratory arrest in adults with acute epiglottitis. Report of 2 cases]. / Parada cardiorrespiratoria súbita en adultos con epiglotitis aguda presentación de dos casos.

We report two adult cases of sudden cardiorespiratory arrest because an acute epiglottitis that ocurred in our hospital. Although it is an uncommon pathology nowdays with good prognosis generally, we try to call the attention about this complication which can happen of unforseeable way even in previous absence of respiratory obstruction. One of the patients required coniotomy in ICU due to impossibility of orotracheal intubation (OI) and the other died in spite of an urgent performance.

Septic epiglottic chondritis with abscessation in 2 young Thoroughbred racehorses.

Septic epiglottic chondritis with abscessation diagnosed in 2 Thoroughbred racehorses. Infected cartilage removed videoendoscopically followed by systemic antibiotics. The infectious process was successfully controlled, but permanent dorsal displacement of the soft palate (DDSP) with a shortened, deformed epiglottic cartilage developed. Surgery for the DDSP using bilateral partial sternothyroidectomy or laryngeal tie-forward failed.

Adult acute epiglottitis: experiences in a Taiwanese setting.

OBJECTIVE: Acute epiglottitis is a potentially disastrous disease seen occasionally in otolaryngology emergency service. This study reports our experiences in managing adult patients with acute epiglottitis in a Taiwanese setting. STUDY DESIGN: Admission medical records from 46 adult patients with acute epiglottitis over a period of 8 years in a tertiary referral otolaryngology service were retrospectively reviewed. RESULTS: No mortality was reported; 4 (8.7%) patients were supported by artificial airway. A total of 16 (34.8%) patients had comorbid conditions; hypertension and diabetes mellitus were the most common systemic diseases. Patients who needed artificial airway support tended to have more systemic comorbidities ( P = 0.001) and a higher level of hyperglycemia ( P = 0.004) than those who did not need airway support. The incidences of drooling, stridor/dyspnea, and muffled voice were significantly higher in the airway-supported group ( P < 0.05). Stridor/dyspnea is a reliable clinical predictor of airway compromise (odds ratio 2.94; P = 0.0277). CONCLUSION: Dyspnea is a warning sign of impending airway collapse during an episode of acute epiglottitis. Adult patients with more systemic comorbidities might bear higher risk of airway compromise; the role of diabetes mellitus can't be overlooked.

Descending necrotizing mediastinitis following acute epiglottitis: a case report.

Descending necrotizing mediastinitis occurs secondary to deep neck infection, and the primary focus of infection is mostly located in the tonsil, pharynx and carious tooth. DNM following acute epiglottitis is quite rare, with only one case reported. We treated an 84-year old female with an acute epiglottitis followed by DNM. She was successfully treated by drainages with cervical surgery combined with thoracotomy and cervical surgery.

Otolaryngologic critical care.

In this chapter we have reviewed the complicated medical conditions that exist in many head and neck surgical patients. Common surgical procedures that frequently require postoperative monitoring and several infectious disorders requiring intensive care unit admission were also reviewed. Intensivists need to be familiar with these procedures and diseases. Collaboration with the surgical specialist is required to optimize patient care.

[Dyspnea analyse and treatment to adult acute epiglottitis].

OBJECTIVE: To discuss the estimation and treatment of adult acute epiglottitis dyspnea. METHOD: 126 adult with acute epiglottitis patients were analyzed. RESULT: None of 30 patients undergone epiglotiotomy had asphyxia, inflammation diffuse or serious hemorrhage. 8 patients undergone tracheotomy, one patient undergone thyroericotomy but died. One of 87 patients with conservative treatment died. CONCLUSION: Gaspping, salivating and dyslogia are symbols of severe larynx obstruction. Fibrous laryngoscope is the best way of examine. Keeping respiratory path open and eliminating epiglottis swelling is the key of treatment.

Acute epiglottitis: a review of 80 patients.

We reviewed 80 patients admitted to our hospital who were diagnosed with acute epiglottitis between January 1995 and March 1999, and their clinical features, evolution and treatments were analysed. No sexual predominance was found, and there was no patient younger than 16 years of age. The patient fatality rate was 1.3 per cent, and the hospitalization period was markedly longer than those of other reports.

Adult epiglottitis: an under-recognized, life-threatening condition.

Epiglottitis in the adult can be fatal and should be treated with the same degree of concern and suspicion in respect of airway patency as in children. We present three cases of adult epiglottitis in which the airway was lost prior to or during the intervention of an anaesthetist. We suggest that an emphasis on conservative management is distracting and belies the serious nature of this disease.