Acute epiglottitis (AE), an inflammation of the epiglottis and adjacent supraglottic structures, can lead to a fatal airway obstruction. We report the case of a 47­year­old male who developed AE after experiencing a sore throat, odynophagia, and high­grade fever for a week. The patient came in with late signs of AE, suggesting a poor prognosis. Laryngoscopy revealed a swollen epiglottis obstructing the patient’s tracheal opening. He had cardiopulmonary arrest due to the airway obstruction. The patient was successfully resuscitated but had several episodes of generalized seizure after the return of spontaneous circulation. He was discharged in a persistent vegetative state. Because AE is unusual in the adult population, a clinician's high index of suspicion for the diagnosis and the emergency team’s prompt intervention are crucial factors in the management approach to AE. Physicians working in the emergency room must be equipped with skills in establishing a definitive airway, especially in securing a surgical airway.
Epiglottitis ; Laryngoscopy ; Tracheostomy ;

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a life-threatening condition that can result in airway obstruction. The present study reports clinical features, management and patient outcomes in an acute epiglottitis. SUBJECTS AND METHOD: Included in our retrospective study were 315 patients who were admitted with the diagnosis of acute epiglottitis between January 2006 and July to the department Otolaryngology-Head and Neck surgery, Hallym University Sacred Heart Hospital 2018. The diagnosis of acute epiglottitis was established by confirmation of inflamed epiglottis using laryngoscope or computed tomography. RESULTS: Among 315 patients, 89 cases (28%) and 83 cases (26%) were found in the fifth and fourth decades, respectively. The mean age of patients was 45.0±13.94 years. The male to female ratio was 1.33:1. A total of 75 patients (23.8%) had co-morbidities, with hypertension (13.6%) being the most common. Fever was relatively uncommon, whereas most patients complained of sore throat. Ceftriaxone was the most common empirical antibiotic regimen prescribed and the use of steroids did not affect the length of hospital stay. Nine patients required airway intervention, including eight who underwent endotracheal intubation and one emergency tracheostomy. In patients who need airway intervention, systolic blood pressure, body temperature, respiratory rate, heart rate, white blood cells and the proportion of dyspnea were significantly higher in comparison to the patients without airway intervention. CONCLUSION: Although acute epiglottitis often has nonspecific symptoms, it may lead to sudden dyspnea and unstable vital signs, so an in-depth understanding of this disease is needed.
Airway Obstruction ; Anti-Bacterial Agents ; Blood Pressure ; Body Temperature ; Ceftriaxone ; Clinical Study ; Diagnosis ; Dyspnea ; Emergencies ; Epiglottis ; Epiglottitis ; Female ; Fever ; Heart ; Heart Rate ; Humans ; Hypertension ; Intubation, Intratracheal ; Korea ; Laryngoscopes ; Length of Stay ; Leukocytes ; Male ; Methods ; Neck ; Pharyngitis ; Respiratory Rate ; Retrospective Studies ; Steroids ; Tracheostomy ; Vital Signs

PURPOSE: Acute epiglottitis is a potentially fatal condition that can result in airway obstruction. The aim of this study is to examine the clinical features of adult patients who visited the emergency department (ED) with acute epiglottitis. METHODS: This retrospective observational study was conducted at a single tertiary hospital ED from November 2005 to October 2015. We searched our electronic medical records (EMR) system for a diagnosis of "acute epiglottitis" and selected those patients who visited the ED. RESULTS: A total of 28 patients were included. There was no pediatric case with acute epiglottitis during the study period. The mean age of the patients was 58.0+/-14.8 years. The peak incidences were in the sixth (n=7, 25.0%) and eighth (n=8, 28.6%) decades. The male-to-female ratio was 2.1:1. The most common symptom was sore throat (n=23, 82.1%), followed by dyspnea (n=15, 53.6%), hoarseness (n=7, 25.0%), fever (n=6, 21%), and dysphagia (n=5, 17.9%). The diagnosis of acute epiglottitis was confirmed when edema and hyperemia of the epiglottis were visualized by laryngoscopy. Twenty-six patients were treated conservatively with antibiotics and steroids without definite airway management. Two patients were intubated, but no patients required tracheostomy. CONCLUSION: In adult patients with acute epiglottitis, sore throat and dyspnea were the most common symptoms but fever was infrequent. Most patients improved with conservative management only. Definite airway management was required in only two patients in whom endotracheal intubations were performed successfully in the ED by emergency physicians, and surgical airway management was not required.
Adult* ; Airway Management ; Airway Obstruction ; Anti-Bacterial Agents ; Deglutition Disorders ; Diagnosis ; Dyspnea ; Edema ; Electronic Health Records ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Epiglottis ; Epiglottitis* ; Fever ; Hoarseness ; Humans ; Hyperemia ; Incidence ; Intubation, Intratracheal ; Laryngoscopy ; Observational Study ; Pharyngitis ; Retrospective Studies ; Steroids ; Tertiary Care Centers ; Tracheostomy

PURPOSE: Croup is a common pediatric respiratory illness with symptoms of varying severity. Moreover, epiglottitis is a rare disease that can rapidly progress to life-threatening airway obstruction. Although the clinical course and treatments differ between croup and epiglottitis, they are difficult to differentiate on presentation. We aimed to compare the clinical characteristics of croup and epiglottitis in Emergency Department patients. METHODS: The 2012 National Emergency Department Information System database of 146 Korean Emergency Departments was used to investigate patients aged < or =18 years presenting with croup or epiglottitis. RESULTS: We analyzed 19,374 croup patients and 236 epiglottitis patients. The male:female sex ratios were 1.9:1 and 2.3:1 and mean ages were 2.2+/-2.0 and 5.6+/-5.8 years, respectively. The peak incidence of croup was observed in July and that of epiglottitis was observed in May. The hospitalization rate was lower in croup than in epiglottitis patients, and the proportion of patients treated in the intensive care unit was lower among croup patients. The 3 most common chief complaints in both croup and epiglottitis patients were cough, fever, and dyspnea. Epiglottitis patients experienced dyspnea, sore throat, and vomiting more often than croup patients (P<0.05). CONCLUSION: Both groups had similar sex ratios, arrival times, 3 most common chief complaints, and 5 most common comorbidities. Epiglottitis patients had a lower incidence rate, higher mean age of onset, and higher hospitalization rate and experienced dyspnea, sore throat, and vomiting more often than croup patients. Our results may help in the differential diagnosis of croup and epiglottitis.
Adolescent* ; Age of Onset ; Airway Obstruction ; Child* ; Comorbidity ; Cough ; Croup* ; Diagnosis, Differential ; Dyspnea ; Emergencies* ; Emergency Service, Hospital* ; Epiglottitis* ; Fever ; Hospitalization ; Humans ; Incidence ; Information Systems ; Intensive Care Units ; Korea* ; Pharyngitis ; Rare Diseases ; Sex Ratio ; Vomiting

Acute epiglottitis is an inflammation of the epiglottis and adjacent structures. Although the incidence is extremely rare, acute epiglottitis is a life-threatening medical emergency and can cause sudden respiratory obstruction. Herein, we describe two cases of sudden death from epiglottitis and epiglottic abscess. A 39-year-old man and 66-year-old man died after suffering from shortness of breath. Autopsies revealed diffuse swelling and abscess formation in the epiglottis and neighboring structures. These cases emphasize the medicolegal importance of sudden death from acute epiglottitis and epiglottic abscess in adults.
Abscess* ; Adult* ; Aged ; Airway Obstruction ; Autopsy ; Death, Sudden* ; Dyspnea ; Emergencies ; Epiglottis ; Epiglottitis* ; Humans ; Incidence ; Inflammation

Acute epiglottitis though relatively common in pediatric patients as compared to adults, present with almost similar clinical presentations. They include voice change, difficulty or painful swallowing and sometimes with upper airway obstruction. Physical finding of swollen epiglottis is difficult to be obtained owing to the danger of introducing laryngeal mirror into the oropharynx as to avoid contact spasm. The diagnostic thumb sign appearance on lateral neck radiograph is considered pathognomonic of epiglottitis. We report a case of an adult with clinical features and radiological finding of an acute epiglottitis, which did not resolve with antibiotic treatment. Subsequent imaging confirmed the presence of an abscess in the epiglottic mucosa.
Epiglottitis

Acute bacterial upper respiratory infections include acute rhinosinusitis, acute pharyngotonsillitis, acute laryngitis, and acute epiglottitis. These are common reasons for primary care visits. Acute bacterial sinusitis usually occurs as a secondary complication of acute viral sinusitis. Acute viral sinusitis will recover over the course of 7-10 days without antibiotics. Amoxicillin is a drug of choice for acute bacterial sinusitis in the practice guidelines. Patients with acute pharyngotonsillitis should be treated with antibiotics (amoxicillin) for 10 days with the purpose of prevention of rheumatic fever. Use of rapid antigen detection should be encouraged for the appropriate use of antibiotics, especially in Korea. Etiologies of acute laryngitis in adults are mainly viruses. However, M. pneumoniae, M. catarrhalis, H. influenzae are major bacterial pathogens of laryngtitis. Acute epiglottitis, cellulitis of the epiglottis, is a life-threatening infection. Airway keeping and antibacterial therapy against H. influenzae and other bacterial pathogens are main stays of management. Evidence-based approach is greatly in need for appropriate care for patients with bacterial upper respiratory infections.
Adult ; Amoxicillin ; Anti-Bacterial Agents ; Bacterial Infections ; Cellulitis ; Epiglottis ; Epiglottitis ; Evidence-Based Practice ; Humans ; Influenza, Human ; Korea ; Laryngitis ; Pneumonia ; Primary Health Care ; Respiratory Tract Infections ; Rheumatic Fever ; Sinusitis

PURPOSE: We wanted to predict the high risk group that requires urgent airway intervention by using the parameters of the soft-tissue lateral neck radiographs of adult acute epiglottitis patients. METHODS: This retrospective study was conducted in two teaching hospitals. The patients who were diagnosed with acute epiglottitis from June, 2007 to May, 2009 were enrolled and their medical records and x-ray films were reviewed. The width of the epiglottis at the widest point (EW), the width of the arytenoid at the widest point (AW), the prevertebral soft tissue distance at the third cervical spine (PSTD), the shortest distance from the epiglottis to the hypopharyngeal wall (EHD) and the shortest distance from the epiglottic root to the arytenoids'tip (EAD) were investigated and we performed regression analyses of these parameters of the patients in the high risk group that required urgent airway intervention. RESULTS: A total of 42 patients were enrolled. Dyspnea and hoarseness were more frequent in the high risk group that required urgent airway intervention (p=0.008, 0.040, respectively). The EW was significantly longer (p=0.001) in the high risk group. The EHD and EAD were significantly shorter (p=0.012, <0.001, respectively) in the high risk group. Only the EAD showed significant correlation with the percent of airway patency on linear regression analysis (p=0.003) and the EAD was the only significant predictor for the high risk group on multivariate logistic regression analysis (p=0.043). The receiver operating characteristics curve of the EW/EAD for the high risk group was obtained and it showed the best predictive power (AUC: 0.977, p<0.001). CONCLUSION: The EAD noted on soft-tissue lateral neck radiography is an important predictor of high risk patients who require urgent airway intervention. The cut-off value of the EW/EAD for the predicting the high risk group is 2.44 (sensitivity 100%, specificity 85.7%).
Adult ; Airway Obstruction ; Dyspnea ; Epiglottis ; Epiglottitis ; Hoarseness ; Hospitals, Teaching ; Humans ; Linear Models ; Logistic Models ; Medical Records ; Neck ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spine ; X-Ray Film

Acute epiglottitis is a local bacterial infection of the supraglottic area. Epiglottitis is generally caused by organisms which invoke an inflammatory response that develops rapid obstructive edema. The disease rarely progresses to abscess stage, either because medical intervention is sought or death by asphyxiation ensues. A 38-year-old, mentally ill but physically healthy woman died of airway obstruction caused by acute epiglottitis forming an abscess. She died unexpectedly and suddenly showing only minor nonspecific symptoms.
Abscess* ; Adult ; Airway Obstruction ; Bacterial Infections ; Death, Sudden* ; Edema ; Epiglottitis ; Female ; Humans ; Mentally Ill Persons

Scrub typhus is an endemic rickettsial disease with annual seasonal outbreak in Korea and its incidence is increasing. Recently, cases of scrub typhus with severe complications, such as septic shock, acute respiratory distress syndrome, acute renal failure, myocarditis, disseminated intravascular coagulation and meningitis have been increasingly reported. Acute epiglottitis is the one of potentially life- threatening scrub typhus related complications. Its initial clinical manifestations are sore throat, dysphagia or dyspnea. Although 22-62% of scrub typhus patients complain of sore throat, the etiology and optimal therapy are not yet known. We experienced 3 cases of scrub typhus-associated acute epiglottitis which rapidly responded to short-term corticosteroid administration.
Acute Kidney Injury ; Deglutition Disorders ; Disseminated Intravascular Coagulation ; Dyspnea ; Epiglottitis* ; Humans ; Incidence ; Korea ; Meningitis ; Myocarditis ; Pharyngitis ; Respiratory Distress Syndrome, Adult ; Scrub Typhus* ; Seasons ; Shock, Septic