Epiglottitis

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