Epiglottitis 29/09/2022, 8:57 PM

Epiglottitis
 ! 30 views " 0

Overview and epidemiology

Acute inflammation in the supraglottic region of the oropharynx is called an epiglottis. It is an uncommon disease. The incidence
of epiglottitis in adults is about 1 case per 100,000 per year. It affected male adults more than female adults (male-to-female ratio,
approximately 3:1). It occurs mostly during the fifth decade of life (average age, about 45 year old). 

Etiology
The most common organisms that cause acute epiglottitis are haemophilus influenzae (25%), followed by h para influenzae,
streptococcus pneumoniae, and group A streptococci. Other bacteria, viruses, and fungi can cause  epiglottis but they are less
common. Older age, a body mass index of over 25.0 kg/m2, and the presence of diabetes mellitus, epiglottic cyst, or pneumonia
increased the risk for severe epiglottitis in adults. 

History and symptoms

The onset and progression of symptoms of epiglottitis is rapid. The following are the symptoms of epiglottitis:  

Sore throat 

Odynophagia/dysphagia 

Muffled voice – “Hot potato voice,” as if the patient is struggling with a mouthful of hot food 

Stridor 

Upper respiratory tract infection (URTI) symptoms

Mild cough 

Physical examination
A definitive diagnosis is made by the direct visualization of an erythematous and swollen epiglottis under laryngoscopy with
equipment to secure the airway. If you examine the throat without securing the airway you may provoke the risk of airway spasm or
obstruction leading to death. On physical examination, patients with epiglottitis may present with the following:  

Appearance of the Patient 

Hyper-extension of the neck, chin pointing forward with trunk and arms leaning forward which is called the tripod
posture

Toxic appearance of patient 

Stridor, muffled voice, horsiness  

Irritability 

Vital Signs 

High temperature 

Tachycardia 

Hypoxia 

HEENT 

Inflamed epiglottis 

Pharyngeal redness 

Neck 

https://saudifamilymedicine.com/index.php/documentation/section-1-fm/chapter-5-upper-respiratory-tract-infections/epiglottitis/ Page 1 of 3
Epiglottitis 29/09/2022, 8:57 PM

Tenderness of anterior neck 

Cervical lymphadenopathy 

Lungs 

Respiratory distress 

Increased respiratory rate 

Decreased air-entry depending on degree of airway obstruction 

Extremities 

Cyanosis 

Laboratory 

There are no specific investigations to diagnose epiglottitis, however the following investigation may help:  

CBC for leukocytosis 

Blood culture and throat culture should done under intubation for organism specification  

Arterial blood gas to show respiratory acidosis  

Radiology 

The thumbprint sign is a classic finding on the lateral neck x-ray.

Management
Regardless of the severity of the patient’s condition at the time of presentation deterioration may occur rapidly at any time.
Transferring patients immediately to an appropriate secondary care facility such as EMS immediately is warranted. 

Epiglottitis is a medical emergency. Patient’s airway needs to be secured in case of respiratory distress. Once the airway is secured
the examination, investigation, and management can commence as below in the secondary care setting. This should not be done in
primary care. 

Avoid agitating the patient and let the patient take a position in which feels comfortable. 

The first-line interventions for epiglottitis are administering high-flow oxygen, establishing intravenous access, and calling
the ENT specialist.  

Intubation may be required and the equipment for intubation, cricothyroidotomy, or needle-jet should be at the bedside.  

Avoid therapy such as sedation.  

Antipyretic agents may also be necessary. 

Adjuvant therapy may be used which includes corticosteroids and racemic epinephrine. The corticosteroid may help to
decrease the obstruction, the need of airway intervention, and the length of the hospitalizations. 

Start appropriate empiric antibiotic regimen (Table 5.7) intravenously to cover the most common organisms: s. pneumoniae,
beta-hemolytic strep, and staph aureus. The optimal duration for the treatment of acute epiglottitis is usually a 7–10 day
course of intravenous antibiotics.

Antibiotic Pediatric dose Adult dose

Ceftriaxone  50–100 mg/kg/day once daily or divided into two doses(Maximum daily dose 2 2 g every 24 hours 
g .)

Cefotaxime  150–200 mg/kg/day in 4 divided doses (Maximum daily dose 10 g) 2 g every 4–8 hours  

Vancomycin  40–60 mg/kg/day in 3–4 divided doses(Maximum daily dose 2 g) 2 g per day IV every 6–12
hours 

Clindamycin  30–40 mg/kg/day in 3–4 divided doses(Maximum daily dose 2.7 g) 600–900 mg every 8 hours 

Levofloxacin  8 mg/kg every 12 hours  750 mg every 24 hours 

https://saudifamilymedicine.com/index.php/documentation/section-1-fm/chapter-5-upper-respiratory-tract-infections/epiglottitis/ Page 2 of 3
Epiglottitis 29/09/2022, 8:57 PM

Table 5.7 – Antibiotics and doses for epiglottis treatment

Prognosis and complications

The prognosis of acute epiglottitis is good if treated early. The edema can lead to swelling in the epiglottic and supraglottic areas
and if unrecognized epiglottitis may rapidly lead to airway obstruction and death. The following are possible complication of
epiglottitis: 

Meningitis 

Epiglottic abscess 

Cervical adenitis 

Vocal granuloma 

Subsequent necrotizing fasciitis of the head and neck (rare) 

Cartilaginous metaplasia of the epiglottis 

Pneumonia 

Pulmonary edema 

Empyema 

Pneumothorax 

Pneumomediastinum (rare) 

Pericarditis 

Septic arthritis 

Cellulitis 

Septic shock 

Death (asphyxia)

https://saudifamilymedicine.com/index.php/documentation/section-1-fm/chapter-5-upper-respiratory-tract-infections/epiglottitis/ Page 3 of 3