Epiglottitis Clinical Presentation

Updated: Feb 08, 2017
  • 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. [11] 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. [12] 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 [13]
  • Mild cough
  • Irritability
  • Tachycardia
  • Toxic appearance of patient
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