Epiglottitis Clinical Presentation

  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Jul 14, 2011
 

History

The onset and progression of symptoms of epiglottitis is rapid (George Washington woke up with a sore throat and died the same night), although a less fulminant presentation is frequently demonstrated in adolescents and adults.

Historically, acute epiglottitis was most common in children aged 2-4 years. Since the introduction of the Hib vaccine and the accompanying dramatic reduction in H influenzae type b invasive disease incidence, epiglottitis has become rare in children. A comparison made between a large US children's hospital's chart review from 1995 to 2003 and a previous report from the same hospital completed 27 years earlier, showed a 10-fold decline in acute epiglottitis admissions, with streptococci becoming the major pathogens.[7] Epiglottitis incidence in adults has remained constant.

In a 2005 retrospective review of patients with acute epiglottitis, symptoms of stridor, voice muffling, rapid clinical course, and a history of diabetes mellitus were significantly associated with the need for airway intervention.[8] The following symptoms are also reported:

  • Sore throat (95%)
  • Odynophagia/dysphagia (95%)
  • Muffled voice (54%) - "Hot potato voice," as if the patient is struggling with a mouthful of hot food
  • Adults may have preceding upper respiratory tract infection (URTI) symptoms.
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Physical Examination

Physical findings of epiglottitis may include the following:

  • Tripod position - Sitting up on hands, with the tongue out and the head forward
  • Drooling/inability to handle secretions
  • Stridor: A late finding indicating advanced airway obstruction
  • Muffled voice (54%)
  • Cervical adenopathy
  • Fever
  • Hypoxia
  • Respiratory distress
  • Severe pain on gentle palpation over the larynx or hyoid bone[9]
  • Mild cough
  • Irritability
  • Tachycardia
  • Toxic appearance of patient
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Contributor Information and Disclosures
Author

Sandra G Gompf, MD, FACP, FIDSA  Associate Professor of Infectious Diseases and International Medicine, University of South Florida College of Medicine; Chief, Infectious Diseases Section, Director, Occupational Health and Infection Control Programs, James A Haley Veterans Hospital

Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey Glenn Bowman, MD, MS  Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD  Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Young LS, Price CS. Complicated adult epiglottitis due to methicillin-resistant Staphylococcus aureus. Am J Otolaryngol. Nov-Dec 2007;28(6):441-3. [Medline].

  2. Kavanagh KR, Batti JS. Traumatic epiglottitis after foreign body ingestion. Int J Pediatr Otorhinolaryngol. Jun 2008;72(6):901-3. [Medline].

  3. Wallenborn PA 3rd, Postma DS. Radiation recall supraglottitis. A hazard in head and neck chemotherapy. Arch Otolaryngol. Sep 1984;110(9):614-7. [Medline].

  4. Berg S, Trollfors B, Nylén O, Hugosson S, Prellner K, Carenfelt C. Incidence, aetiology, and prognosis of acute epiglottitis in children and adults in Sweden. Scand J Infect Dis. 1996;28(3):261-4. [Medline].

  5. Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. Aug 2008;122(8):818-23. [Medline].

  6. Chan KO, Pang YT, Tan KK. Acute epiglottitis in the tropics: is it an adult disease?. J Laryngol Otol. Sep 2001;115(9):715-8. [Medline].

  7. Faden H. The dramatic change in the epidemiology of pediatric epiglottitis. Pediatr Emerg Care. Jun 2006;22(6):443-4. [Medline].

  8. Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol. Dec 2005;119(12):967-72. [Medline].

  9. Ehara H. Tenderness over the hyoid bone can indicate epiglottitis in adults. J Am Board Fam Med. Sep-Oct 2006;19(5):517-20. [Medline].

  10. Mathoera RB, Wever PC, van Dorsten FR, Balter SG, de Jager CP. Epiglottitis in the adult patient. Neth J Med. Oct 2008;66(9):373-7. [Medline].

  11. Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Nov 2000;85(5):795-7. [Medline].

  12. Chandradeva K, Palin C, Ghosh SM, Pinches SC. Percutaneous transtracheal jet ventilation as a guide to tracheal intubation in severe upper airway obstruction from supraglottic oedema. Br J Anaesth. May 2005;94(5):683-6. [Medline].

  13. Hung TY, Li S, Chen PS, et al. Bedside ultrasonography as a safe and effective tool to diagnose acute epiglottitis. Am J Emerg Med. Mar 2011;29(3):359.e1-3. [Medline].

  14. Yong MG, Choo MJ, Yum CS, Cho SB, Shin SO, Lee DW, et al. Radiologic laryngeal parameters in acute supraglottitis in Korean adults. Yonsei Med J. Aug 2001;42(4):367-70. [Medline].

  15. Ducic Y, Hébert PC, MacLachlan L, Neufeld K, Lamothe A. Description and evaluation of the vallecula sign: a new radiologic sign in the diagnosis of adult epiglottitis. Ann Emerg Med. Jul 1997;30(1):1-6. [Medline].

  16. Werner SL, Jones RA, Emerman CL. Sonographic assessment of the epiglottis. Acad Emerg Med. Dec 2004;11(12):1358-60. [Medline].

  17. Prasad A, Singh M, Chan VW. Ultrasound imaging of the airway. Can J Anaesth. Nov 2009;56(11):868-9; author reply 869-70. [Medline].

  18. Kim SG, Lee JH, Park DJ, et al. Efficacy of spinal needle aspiration for epiglottic abscess in 90 patients with acute epiglottitis. Acta Otolaryngol. Jul 2009;129(7):760-7. [Medline].

  19. Ito K, Chitose H, Koganemaru M. Four cases of acute epiglottitis with a peritonsillar abscess. Auris Nasus Larynx. Apr 2011;38(2):284-8. [Medline].

  20. [Guideline] Centers for Disease Control and Prevention. Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine. MMWR Morb Mortal Wkly Rep. Mar 14 2008;57(10):258-60. [Medline].

  21. [Guideline] Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Dec 1 2006;55:1-48. [Medline].

 
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Soft-tissue lateral neck radiograph reveals edema of epiglottis consistent with acute epiglottitis.
 
 
 
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