Take Home Points on Epiglottitis
- Epiglottitis has demonstrated a resurgence in the adult population. It is no longer a pediatric only disease.
- The classic presentation of epiglottitis (3Ds of drooling, dysphagia and distress) is uncommon
- Epiglottitis should be high on your differential for the bounce-back patient who continues to complain of worsening sore throat
- Definitive diagnosis is made by flexible fiberoptic laryngoscopy
- Be ready for a difficult airway
REBEL Core Cast 11.0 – Epiglottitis
Definition: Acute infection and inflammation of the supraglottic soft tissue structures which can lead to airway occlusion. Develops over 2-7 days and is considered an ENT emergency.
- Incidence of 3 – 5:100,000 per year. Mortality between 7-20%.
- Mean age of those affected is 55. Child:adult ratio of 0.3:1 (due to vaccines)
- Risk factors include smoking, diabetes, immunocompromised.
- Broad range of causative organisms, but most commonly caused by various strep and staph species.
- Traditionally taught as a children’s disorder caused by Haemophilus influenzae type B with the 3 D’s, drooling, dysphagia and distress. However due to life saving vaccines we went from a child:adult ratio of 2.6:1 to 0.3:1. (Shah 2010)
Can be difficult to diagnose and some studies say that it is missed as often as 80% of the time. Initial presentation may mimic symptoms of your garden variety URI or strep throat. Think about this disease when patient presents to the ER for a second time for worsening sore throat, pain to palpation of neck, dysphagia and hoarseness.
- Fiberoptic nasal layngoscopy
- Gold standard diagnostic test
- Lateral neck xray
- 90% sensitivity
- Classic finding of “thumbprint” sign due to epiglottis thickened with inflammation
- CT scan
- Equally as sensitive as lateral neck x-ray. May be useful if diagnosis unclear.
- Refrain from using supraglottic devices as it could compress swollen epiglottis
- Fiberoptic awake intubation may be ideal if you have necessary equipment and skill set
- Consult ENT, surgery, anesthesia early to help with airway if needed
- Ampicillin-sulbactam or Amoxicillin-clavulanate are the preferred initial antibiotic recommendations
- Vancomycin for patients that are critically ill and suspicion for MRSA infection
- NSAID/Corticosteroids for pain control and inflammation
- Consider admission for observation though not always necessary
- If advanced inflammation or respiratory symptoms should go to ICU
Show Notes Written By: Miguel Reyes, MD (Twitter: @Miguel_ReyesMD)
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)