Epiglottitis

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

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

Swollen, erythematous epiglottis on laryngoscopy

Unlike in children, indirect laryngoscopy is generally safe

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