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.

Pathological characteristics of the epiglottis relevant to acute epiglottitis.

OBJECTIVE: The characteristic swelling of acute epiglottitis is thought to be caused by histological factors in the epiglottis. We investigated the relationships between histological findings and the pathology of acute epiglottitis. METHODS: We examined 23 autopsy cases. For 16 of these, histological assessments were performed. In the remaining 7 subjects, physiological saline was injected at the lingual tonsil. RESULTS: These histological findings revealed abundant laryngeal glands on the laryngeal surface compared with the lingual surface. With regard to the blood vessels and lymphatic vessels, more of these vessels tended to be apparent on the lingual surface compared with the laryngeal surface. In each of the physiological saline injected subjects, almost no swelling of the lingual tonsil occurred, but the lingual surface of the epiglottis was swollen, and morphological changes had occurred that resembled those in acute epiglottitis. CONCLUSION: Periepiglottic tissues are rich in lymphatic tissues, and it appears easy for inflammation to spread to the epiglottis itself via the gland's own rich networks of blood and lymphatic vessels. In addition, according to the video observation, it appeared that the liquid ingredient that exudes at the inflamed the lingual tonsil may cause swelling the lingual surface of the epiglottis.

Symptoms and signs differentiating croup and epiglottitis.

AIM: To determine differentiating symptoms and signs of epiglottitis and laryngotracheobronchitis (croup). METHODS: Contemporaneous interview of parents and clinical examination of children with acute upper airway obstruction presenting to the intensive care unit of a paediatric hospital. RESULTS: Two hundred and three children were examined over a 40-month period. One hundred and two had croup, of whom 49 had the diagnosis confirmed at intubation and another six by direct laryngeal inspection without intubation. One hundred and one had epiglottitis of whom 95 were diagnosed by direct inspection of the larynx at intubation, five by a lateral X-ray of the neck and one on direct inspection without intubation. One child with epiglottitis died. Although both illnesses presented with stridor, the additional presence of drooling had a high sensitivity (0.79, 95% CI 0.70-0.86) and specificity (0.94, 95% CI 0.88-0.97) for epiglottitis while coughing had a high sensitivity (1.00, 95% CI 0.96-1.00) and high specificity (0.98, 95% CI 0.93-0.99) for croup. Coughing predicted croup but drooling predicted epiglottitis. Additional reliable signs of epiglottitis were a preference to sit, refusal to swallow and dysphagia. Thirty-seven percent of children with epiglottitis and 16% with croup were treated as having another respiratory illness at least once before definitive diagnosis. CONCLUSIONS: Epiglottitis and croup are often confused because they share symptoms and signs including stridor. However, differentiation in early illness is possible by additional observation of coughing and absence of drooling in croup and by the additional observation of drooling with absence of coughing in epiglottitis.

Epiglottitis and croup.

Infections of the upper airways are a frequent cause of morbidity in children. Viral laryngotracheobronchitis (croup) is the most common cause of stridor in children and usually has a self-limited course with occasional relapses in early childhood. Epiglottitis has become rare in developed countries with the advent of universal vaccinations against Haemophilus influenzae. It can be rapidly fatal, however, if not promptly recognized and appropriately managed. This article reviews the pathogenesis, epidemiology, clinical presentation, diagnosis, and management of these pediatric upper airway infections.

Varicella with stridor: think group A streptococcal epiglottitis.

Bacterial superinfection complicating varicella is not uncommon, but airway complications are rare. We report a case of varicella in a 2-year-old boy complicated by life-threatening stridor secondary to group A streptococcal epiglottitis.

Inhalational versus intravenous induction. A survey of emergency anaesthetic practice in the United Kingdom.

A survey was constructed to ascertain the views of The Royal College of Anaesthetists tutors regarding the acceptability of inhalational induction with sevoflurane for emergency anaesthesia. A questionnaire was sent to all tutors asking them to indicate their preferred choice of anaesthetic technique, and whether they believed inhalation induction with sevoflurane to be acceptable, in each of four scenarios: acute epiglottis; bleeding after tonsillectomy; appendicitis; and laparotomy in the shocked patient. Two hundred and sixty-two (89%) completed questionnaires were received from 294 college tutors. We have shown that the majority of The Royal College of Anaesthetists tutors would use sevoflurane for patients with an acutely compromised airway. One in four college tutors would accept the use of sevoflurane for a shocked patient for laparotomy. Anaesthetists who manage critically ill patients with an inhalational induction should be reassured by the fact, that a significant proportion of their colleagues would find this technique acceptable.

Viral supraglottitis in an adult: a case presentation and literature update.

Viral epiglottitis (supraglottitis) is a rare entity but its presentation can mimic that of bacterial epiglottis. Regardless of the causative agent, supraglottitis is a serious disease mostly affecting children and rarely seen in adults. Early suspicion and proper evaluation are mandatory to prevent a life-threatening crisis. In both children and adults the infectious aetiology in supraglottitis is predominantly bacterial while viruses are rare, especially in adults. We describe a case of supraglottitis in an adult in which the symptoms were insidious and blood indices suggested a bacterial aetiology. However, laryngoscopic examination revealed an ulcer over the left aryepiglottic fold and serology was positive for Herpes simplex virus (HSV) IgM. Because supraglottitis due to HSV is a rare entity with few reported cases in the literature, this case is presented to highlight the viral involvement in this disease and its management.

Acute airway obstruction following facial scalding: differential diagnosis between a thermal and infective cause.

A 16-month-old boy received a 6 per cent hot water scald to his face and chest. The child had been suffering from an upper respiratory tract infection for 10 days prior to the injury. However, as the child rapidly developed respiratory tract obstruction, a differential diagnosis between acute infective epiglottitis and thermal injury to the hypopharynx was required. In fact, the hot water had reached the epiglottis and the aryepiglottic folds causing significant damage, whilst sparing the tongue and mouth. The child was admitted to the intensive care unit, intubated and ventilated for 4 1/2 days. The external burns eventually healed spontaneously. This case report demonstrates the rare occurrence of a minor scalding injury resulting in significant obstruction to the upper airway. Of additional interest is the presence of pre-existing symptoms of an upper respiratory tract infection and the total absence of any signs of intraoral burning. These additional factors demonstrate the necessity for absolute vigilance in the management of any scald in the region of a child's mouth. Intubation can be life saving and should be considered in any case of scalding associated with increasing respiratory distress.

[Acute epiglottitis in the adult]. / Epiglotitis aguda en el adulto.

Epiglottitis is a well-defined syndrome caused by Haemophilus influenzae type B in children. It also may affect adults and has an unpredictable clinical course, sometimes complicated with airway obstruction. Two cases of adult epiglottitis are reported. The first responded favorably to medical treatment and the second required emergency airway surgery. Indicators of poor prognosis are described. Epiglottitis should be considered in the differential diagnosis as a potentially lethal cause of sore throat.

Epiglottitis in adults.

Acute epiglottitis has become a disease of adults, probably as a result of immunization of children against Haemophilus influenzae. This article is a review of the literature on epiglottitis, including signs and symptoms, investigation, differential diagnosis, and treatment in the emergency department. The microbiology is discussed and the importance of prophylaxis in exposed persons is stressed.

[Review of epiglottitis]. / Revisión de epiglotitis.

Seven cases of acute epiglottitis in children (mean age 38 months) are reported. The major clinical features are described. The review of the literature on current diagnosis and treatment underlined the value of early orotracheal or nasotracheal intubation when this serious condition is suspected.

Epiglotitis. Una urgencia otorrinolaringológica. Presentación de cuatro casos / Epiglottitis. An otorhinolaryngologic emergency. Report of four cases

Se describen cuatro casos de epiglotitis; tres pacientes evolucionaron satisfactoriamente y hubo una defunción por causas múltiples. Los síntomas principales fueron; fiebre, tos, mal estado general, dificultad respiratoria, quejido inspiratorio, polipnea y estridor laríngeo. El diagnóstico clínico se corroboró con estudios de laboratorio y gabinete; el tratamiento consistió en ventilación asistida, nebulizaciones, esteroides y antibióticos