Medical Management of Epiglottitis

Abstract

Epiglottitis is most commonly caused by bacterial infection resulting in inflammation and edema of the epiglottis and neighboring supraglottic structures. Acute infection was once found predominantly in children ages 2 to 6 years old, but with the introduction of the Haemophilus influenzae B (HiB) vaccine the incidence of cases in adults is increasing. Typical clinical presentation of epiglottitis includes fever and sore throat. Evidence of impending airway obstruction may be demonstrated by muffled voice, drooling, tripod position, and stridor. Radiographs can be helpful in diagnosing epiglottitis; however, they should not supersede or postpone securing the airway. An airway specialist such as an otolaryngologist, anesthesiologist, or intensivist should ideally evaluate the patient immediately to give ample time for preparing to secure the airway if necessary. All patients with epiglottitis should be admitted to the intensive care unit for close monitoring.

Keywords: Emergent tracheostomy; Epiglottitis; Stridor; Total airway obstruction.

Figure 1

Computed tomography (CT) scan of the neck with contrast at time of admission. (A) Sagittal cut reveals a mass in the hypopharynx and piriform sinuses; note the limited airway space. (B) Axial cut at the level of the hyoid bone reveals a mass that is 1.4 × 0.5 cm in size. (C) Coronal cut revealing the mass intruding upon the midline of the larynx.

Figure 2

Computed tomography (CT) scan of the neck with contrast 2 days after placement of the tracheostomy. (A) Sagittal cut reveals a mass in the hypopharynx and piriform sinuses; note the limited airway space. (B) Axial cut at the level of the hyoid bone reveals a mass that is 1.4 × 0.5 cm in size.

Figure 3

Classic radiographic findings. (A) Lateral radiograph of the neck revealing “thumb sign” appearance of epiglottitis. (B) Anteroposterior radiograph of the neck revealing “steeple sign” seen in croup.