RESUMO
INTRODUCTION: Acute epiglottitis is not uncommon and it can cause high mortality due to airway obstruction. Acute epiglottitis complicated with cervical necrotizing fasciitis has rarely been reported, and it is also a life-threatening disease with a fatality rate of 7% to 50%. PATIENT CONCERNS: A 64-year-old woman presented to our hospital with chief complaints of sore throat and cervical swelling, long with foreign body sensation and hoarseness. Endoscopic laryngoscopy showed erythematous and swollen epiglottis with purulent secretions on the surface. Computed tomography (CT) scan showed swollen epiglottis and swelling of the neck with air- and fluid-containing necrotizing tissue. DIAGNOSES: The diagnosis was acute epiglottitis and abscess complicated with cervical necrotizing fasciitis. INTERVENTIONS: With the patient in awake condition, airway access was established by performing intubation with adjunctive use of gum elastic bougie, followed by surgical debridement under general anesthesia; a flap was used for skin coverage and intravenous piperacillin-tazobactam was administered. OUTCOMES: The patient was discharged without complications. CONCLUSION: Gum elastic bougie is a usable tool in difficult intubation. Adequate pre-anesthesia evaluation, patient sedation, and gentle manipulation assured the intubation success in this case.
Assuntos
Abscesso , Epiglotite , Fasciite Necrosante , Intubação Intratraqueal , Humanos , Feminino , Fasciite Necrosante/etiologia , Fasciite Necrosante/terapia , Fasciite Necrosante/complicações , Pessoa de Meia-Idade , Epiglotite/complicações , Epiglotite/terapia , Intubação Intratraqueal/métodos , Abscesso/etiologia , Abscesso/terapia , Doença Aguda , Pescoço , Desbridamento/métodos , Laringoscopia/métodos , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Tomografia Computadorizada por Raios X/métodosRESUMO
A multitude of conditions may cause acute and unexpected upper airway compromise in both children and adults. These include mechanical blockage of the airways either from internal obstructions due to inhaled food or foreign objects, or from external compression. In addition, kinking of the airway in cases of positional asphyxia may compromise aeration. Infections represent another cause of airway narrowing with the potential for occlusion. The case of a 64-year-old man with acute laryngo-epiglottitis is used to demonstrate that death may occur from infections in previously structurally-normal airways. Infections may compromise respiration due to acute airway occlusion from intraluminal material/mucus, mural abscesses or from acutely inflamed and oedematous mucosa with adherent tenacious mucopurulent secretions. External compression from nearby abscesses may also critically narrow air passages.
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Obstrução das Vias Respiratórias , Epiglotite , Laringe , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso , Obstrução das Vias Respiratórias/etiologia , Epiglotite/complicações , TraqueiaRESUMO
Epiglottitis is a bacterial infection of the upper respiratory tract that can be rapidly progressive and life-threatening. Though predominantly seen in unvaccinated children, there seems to be a shift with the incidence of adult cases rising following the Haemophilus Influenza B (HiB) vaccine. There are several reports of epiglottitis manifesting as an abscess, but few cases report on the formation of an emphysematous abscess. Additionally, little is known on the bacterial etiology of such infections. Here, we present a case of a patient found to have acute emphysematous epiglottis managed with fiberoptic intubation, drainage, and culture of the abscess. Laryngoscope, 133:2747-2750, 2023.
Assuntos
Epiglotite , Infecções por Haemophilus , Criança , Adulto , Humanos , Infecções por Haemophilus/complicações , Infecções por Haemophilus/diagnóstico , Epiglotite/complicações , Epiglotite/diagnóstico , Epiglotite/terapia , Abscesso/complicações , Doença Aguda , IncidênciaRESUMO
BACKGROUND: Patients undergoing chemotherapy and radiotherapy are placed in an immunocompromised state worth consideration in the event of potential airway compromise, especially when superimposed on an airway-obstructing tumor. We report a case of bacterial epiglottitis in a patient with active oropharyngeal cancer (OPC), who presented in such a way that an infectious etiology was not initially considered in the patient's care. To our knowledge, such a circumstance has not been reported in the literature. CASE: Here, we report a case of a 68-year-old male with advanced-stage OPC who developed respiratory distress and underwent emergent tracheostomy. The patient was diagnosed postoperatively with Haemophilus influenza and Pseudomonas aerugeniosa. Following antibiotic treatment, the patient recovered to the point in which he could then undergo concomitant chemoradiation. The patient later had a recurrence of P. aerugeniosa during their radiotherapy that was also treated with antibiotics. The patient experienced continued symptoms related to their OPC and underwent pharyngectomy. Despite the initial success of this procedure, the patient experienced tumor recurrence and succumbed to his disease. CONCLUSION: This case underscores the importance of considering multiple etiologies concerning airway compromise, as the consequence of delayed cancer treatment may be loss of local cancer control.
Assuntos
Epiglotite , Neoplasias Orofaríngeas , Masculino , Humanos , Idoso , Epiglotite/complicações , Epiglotite/diagnóstico , Epiglotite/terapia , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Orofaríngeas/complicações , Neoplasias Orofaríngeas/diagnóstico , Neoplasias Orofaríngeas/terapia , Quimiorradioterapia/efeitos adversos , Traqueostomia/efeitos adversos , Antibacterianos/uso terapêuticoRESUMO
Acute sore throat is one of the most common problems in general practice. It usually concerns a viral oropharyngeal infection, with good recovery within 10 days. In current guidelines, antibiotics are recommended only in exceptional situations. Although rare, potentially life-threatening complications can occur. Three case histories, on epiglottitis, peritonsillar abscess, and Lemierre syndrome, respectively, demonstrate that acute sore throat can result in severe illness. Early recognition of alarm symptoms, alertness on a complicated disease course, and clinical (re)evaluation (within 1-2 days), are essential. This contributes to the differentiation between a harmless and a serious course, given that serious conditions also have an innocent onset. We highly recommend to consult an ENT specialist when there is doubt about the seriousness of the disease, or correctness of therapy, so timely co-assessment, treatment or transfer can follow. ECMO can be a life-saving treatment when conventional therapy is insufficiently supportive.
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Epiglotite , Medicina Geral , Faringite , Humanos , Faringite/diagnóstico , Faringite/etiologia , Faringite/terapia , Epiglotite/diagnóstico , Epiglotite/terapia , Epiglotite/complicações , Antibacterianos/uso terapêutico , Medicina de Família e ComunidadeRESUMO
OBJECTIVE: In individuals with epiglottitis, chronic obstructive pulmonary disease (COPD) is a common comorbidity; however, the impact of COPD under such circumstances is not well documented. Therefore, we performed this population-based study to determine whether, in adults, COPD is a risk factor for epiglottitis. METHODS: In this retrospective matched-cohort study, data obtained from the Taiwan National Health Insurance Research Database were analyzed. We identified all patients newly diagnosed as having COPD in 2000-2011 and performed frequency matching and propensity-score matching for every patient with COPD individually to another patient without a COPD diagnosis. We used epiglottitis occurrence as the study endpoint, and we investigated the hazard ratio of epiglottitis by using the Cox proportional hazards model after adjustment for potential confounders. RESULTS: In the frequency matching, the cumulative epiglottitis incidence was significantly higher (p = 0.005) in the COPD cohort. According to the adjusted Cox proportional hazard model, COPD exhibited a significant association with elevated epiglottitis incidence (adjusted hazard ratio: 1.76; 95% confidence interval: 1.15-2.70, p = 0.009). Similar trend was observed in the propensity-score matching analysis (adjusted hazard ratio: 1.50; 95% confidence interval: 0.99-2.29, p = 0.057). Our subgroup analysis revealed COPD to be an epiglottitis risk factor in male patients and those aged 40-64 years. CONCLUSIONS: This is the first nationwide matched-cohort research to examine the association of COPD with epiglottitis. Our results revealed that COPD may be a potential risk factor for epiglottitis; thus, clinicians should be mindful of the potential increased risk of epiglottitis following COPD.
Assuntos
Epiglotite , Doença Pulmonar Obstrutiva Crônica , Doença Aguda , Adulto , Estudos de Coortes , Epiglotite/complicações , Epiglotite/epidemiologia , Humanos , Incidência , Masculino , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologiaRESUMO
PURPOSE: Upper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency endonasal endotracheal intubation under videoendoscopic observation. METHODS: Transnasal endoscopic observation was done, and the region of airway stenosis was detected. Then, the endotracheal tube was prepared and the endoscope was inserted into the tube. The endoscope with tube was inserted up to the larynx. Immediately after the administration of lidocaine to the larynx, the endoscope with tube was inserted to the endolarynx and then to the trachea. The endotracheal tube was tightly held in the nostril, and the endoscope was removed. RESULTS: We have encountered four cases this year. The primary disease developing airway stenosis was acute epiglottitis due to pharyngeal and deep neck abscesses in three cases and laryngeal edema due to Ludwig's angina. All patients underwent uneventful intubation, and dyspnea was immediately ceased. CONCLUSION: In cases showing severe suffocation, the clinician should perform airway maintenance even in an outpatient setting apart from a more monitored setting like the operation room. This technique resembles the usual nasal endoscopic laryngeal observation and is done even in the usual ENT office and/or emergency room. The supine position tends to worsen airway stenosis in patients with upper airway stenosis; however, this technique can be performed in a sitting or semi-sitting position. This method is less invasive for patients and also reduces the risk to the medical staff, especially in this COVID-19 era.
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Dispneia/terapia , Endoscopia/métodos , Intubação Intratraqueal/métodos , Laringoestenose/terapia , Estenose Traqueal/terapia , Gravação em Vídeo , Idoso , Idoso de 80 Anos ou mais , Dispneia/etiologia , Epiglotite/complicações , Feminino , Humanos , Edema Laríngeo/complicações , Laringoestenose/etiologia , Masculino , Estenose Traqueal/etiologiaRESUMO
OBJECTIVE: To investigate the incidence of acute epiglottitis (AE) and the clinical features of patients with AE complicated by peritonsillar abscess (PTA), considering that PTA, especially inferior-type PTA, is often a comorbidity of AE. METHODS: We retrospectively reviewed the medical records of patients who were diagnosed as having AE by otolaryngologists and referred to our hospital between January 2009 and December 2017. All the patients underwent laryngeal endoscopy and contrast-enhanced computed tomography (CT) for examination of the severity of AE and its complications by other infections, including PTA. The clinical characteristics of patients with PTA were compared with those of patients without PTA. RESULTS: A total of 139 patients were enrolled, of whom 21 (15%) were found to have PTA. Among the 21 patients, only one had a superior-type PTA and the others had an inferior-type PTA. The patients with complicated AE by an inferior Cap-type PTA frequently showed unilateral arytenoid swelling. CONCLUSION: PTA is a comorbidity of AE, and unilateral arytenoid swelling is considered to suggest the presence of inferior-type PTA.
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Epiglotite/complicações , Abscesso Peritonsilar/complicações , Doença Aguda , Adulto , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/patologia , Endoscopia , Epiglotite/diagnóstico , Feminino , Humanos , Masculino , Abscesso Peritonsilar/diagnóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Tonsillitis, with associated tonsillar hypertrophy, is a common disease of childhood, yet it is rarely associated with sudden death due to airway obstruction. Lethal complications involving the inflamed tonsils include haemorrhage, retropharyngeal abscess and disseminated sepsis. CASE PRESENTATION: We report on a case of sudden and unexpected death in an 8-year-old female who was diagnosed with and treated for tonsillitis. The child was diagnosed with acute tonsillitis 2 days prior to her collapse and was placed on a course of oral antibiotics. There were no signs of upper or lower airway obstruction. She was found to be unresponsive by her caregiver and gasping for air in her bed in the early hours of the second morning after the start of treatment. Autopsy showed massive and symmetrically enlarged palatine tonsils. The tonsils filled the pharynx almost completely. The epiglottis and laryngeal mucosa at the base of the epiglottis in the vicinity of the aryepiglottic membrane and the superior aspect of the larynx displayed red-purple discoloration, with mucosal swelling and edema. Histological examination of the palatine tonsils revealed prominent lymphoid hyperplasia, but no evidence of acute inflammation. CONCLUSION: Palatine tonsillar hypertrophy in infants is a common feature of both viral and bacterial tonsillitis and has been postulated as a possible risk factor for Sudden and Unexplained Death in Infancy (SUDI), based on the theory of mechanical impediment of breathing by narrowing of the upper airway. The rounded shape of the tonsils may facilitate some airflow past the enlarged structures and hence protect against asphyxial death when the enlarged tonsils fill the laryngo-pharynx. Epiglottal and proximal laryngeal edema may play a more significant role in asphyxial unexpected deaths in cases of tonsillitis with tonsillar hypertrophy than previously suspected. This focusses the importance of careful examination of the epiglottis and proximal laryngeal mucosa, as part of a thorough examination of the laryngo-pharynx in cases of sudden death associated with tonsillar hypertrophy.
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Epiglotite , Tonsila Palatina , Criança , Morte Súbita/etiologia , Epiglotite/complicações , Epiglotite/diagnóstico , Feminino , Humanos , Hipertrofia/etiologia , Lactente , ProlapsoAssuntos
Epiglotite/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus pyogenes/isolamento & purificação , Transtornos de Deglutição/etiologia , Epiglotite/complicações , Epiglotite/terapia , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Infecções Estreptocócicas/terapia , TraqueostomiaAssuntos
Epiglotite/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Pré-Escolar , Epiglotite/complicações , Epiglotite/diagnóstico por imagem , Feminino , Humanos , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologiaAssuntos
Dispneia/etiologia , Epiglotite/diagnóstico por imagem , Faringite/etiologia , Amoxicilina/uso terapêutico , Ácido Clavulânico/uso terapêutico , Epiglotite/complicações , Epiglotite/tratamento farmacológico , Humanos , Intubação Intratraqueal , Laringoscopia , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Resultado do TratamentoRESUMO
BACKGROUND: In the winter months, one often sees a large increase in the volume of patients presenting to emergency departments with acute pharyngitis. While most cases of acute pharyngitis are benign, a rare minority can be life threatening. CASE REPORT: We report a case of epiglottis with a concomitant peritonsillar abscess (PTA) in an adult who presented to the emergency department with a sore throat. Computed tomography (CT) scan showed epiglottitis with a developing left PTA. The patient was treated with broad-spectrum antibiotics, high-dose steroids, and underwent multiple laryngoscopies with eventual resolution of his epiglottic swelling. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case serves to highlight the importance of physical examination and CT imaging in identifying patients with pharyngitis who can benefit from additional interventions and monitoring. It is also an unusual example of the presence of two likely related upper respiratory pathologies presenting in the same patient.
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Epiglotite/complicações , Abscesso Peritonsilar/complicações , Faringite/complicações , Adulto , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Epiglotite/tratamento farmacológico , Humanos , Laringoscopia , Masculino , Abscesso Peritonsilar/tratamento farmacológico , Faringite/tratamento farmacológicoAssuntos
Transtornos de Deglutição/microbiologia , Epiglotite/diagnóstico , Infecções por Haemophilus/diagnóstico , Haemophilus influenzae/isolamento & purificação , Faringite/microbiologia , Criança , Epiglotite/complicações , Epiglotite/microbiologia , Infecções por Haemophilus/complicações , Humanos , MasculinoRESUMO
INTRODUCTION: The significant pathogens in acute epiglottitis (AE) are poorly defined in the post Haemophilus influenza type b-vaccine era. Furthermore, there is a lack of clinical evaluations of antibiotic regimens in patients with AE. We aimed to evaluate the effectiveness of empiric intravenous ampicillin in the treatment of patients with AE. MATERIALS & METHODS: All patients admitted with AE to the Ear-Nose-Throat Department, Aarhus University Hospital, Denmark, from 2001 to 2015 were included. RESULTS: In total, 103 (51 males) patients were included in the study. The median duration of hospitalization was four days. There was no statistical significant difference between patients initially treated with intravenous ampicillin (n = 83) or other antibiotics (n = 20) (p = .26). The antibiotic regimen was altered during admission in 11% of patients, without significant difference between antibiotic groups (ampicillin 10% vs non-ampicillin 15%, p = .44). Complications potentially related to insufficient antibiotic treatment were observed in four (5%) patients initially treated with ampicillin, but in none of the patients initially treated with antibiotics other than ampicillin (p = 1.00). Throat swab cultures and blood cultures frequently yielded negative results. CONCLUSIONS: Intravenous ampicillin is efficient as empiric antibiotic therapy for AE patients, leading to a quick recovery and low complication rates.
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Ampicilina/administração & dosagem , Antibacterianos/administração & dosagem , Epiglotite/tratamento farmacológico , Doença Aguda , Administração Intravenosa , Adulto , Ampicilina/efeitos adversos , Antibacterianos/efeitos adversos , Epiglotite/complicações , Epiglotite/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION: Emergency Departments are inundated by patients with respiratory illness during the winter months. Emergency physicians are required to quickly identify critically ill patients among the large volume of patients with mild upper respiratory illness. Among these life-threatening conditions is acute epiglottitis. CASE PRESENTATION: We report a rare series of four adult patients who presented to our Emergency Department during a period of only one week in April 2015 and were ultimately diagnosed with acute epiglottitis. Three of the patients improved with conservative measures and were observed in the intensive care unit. One patient required an emergent tracheostomy. DISCUSSION: This series of patients is unique in that all four patients presented to a single Emergency Department within a few days of each other and, despite a myriad of presenting chief complaints, the patients were eventually found to have the same potentially life-threatening diagnosis.These cases reinforce the variability of presenting symptoms and physical examination findings that can occur in patients with epiglottitis. They also highlight clinical findings and adjunctive testing that can help identify patients who would most benefit from intervention.