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Key Features

  • Suspect epiglottitis (or, more correctly, supraglottitis) when a patient complains of

    • Rapidly developing sore throat

    • Odynophagia (pain on swallowing) which is disproportional to apparently minimal oropharyngeal findings on examination

  • May be viral or bacterial in origin

  • It is more common in persons with diabetes

Clinical Findings

  • Lateral plain film radiographs may demonstrate an enlarged epiglottis (the epiglottis "thumb sign")

  • Swollen, erythematous epiglottis on laryngoscopy

Diagnosis

  • Unlike in children, indirect laryngoscopy is generally safe

Treatment

  • Hospitalization and initial admission to a monitored unit

  • Intravenous antibiotics (eg, ceftizoxime, 1–2 g every 8–12 hours; or cefuroxime, 750–1500 mg every 8 hours)

  • Dexamethasone, usually 4–10 mg as initial bolus and then 4 mg every 6 hours intravenously, and observation of the airway

  • Corticosteroid may be tapered as signs and symptoms resolve. Similarly, substitution of oral antibiotic may be appropriate to complete a 10-day course

  • When epiglottitis is recognized early in the adult, it is usually possible to avoid intubation

  • Less than 10% of adults require intubation

  • Indications for intubation

    • Dyspnea or rapid pace of pharyngitis (where progression to airway compromise may occur before the effects of corticosteroid and antibiotic take hold)

    • Endolaryngeal abscess noted on CT imaging

  • If the patient is not intubated, monitor oxygen saturation with continuous pulse oximetry

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