Epiglottitis Clinical Presentation

Updated: Apr 10, 2018
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Presentation

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. [15] 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. [16] 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.

Next:

Physical Examination

Physical findings of epiglottitis may include the following [17] :

  • 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 [18]

  • Mild cough

  • Irritability

  • Tachycardia

  • Toxic appearance of patient

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