Case Reports

Supraglottitis

Emergency Medicine. 2016 October;48(10):462-466 | 10.12788/emed.2016.0060

References

1. Glynn F, Fenton JE. Diagnosis and management of supraglottitis (epiglottitis). Curr Infect Dis Rep. 2008;10(3):200-204.

2. Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED. Epiglottitis: It hasn’t gone away. Anesthesiology. 2016;124(6):1404-1407. doi: 10.1097/ALN.0000000000001125.

3. Westerhuis B, Bietz MG, Lindemann J. Acute epiglottitis in adults: an under-recognized and life-threatening condition. S D Med. 2013;66(8):309-311, 313.

4. Al-Qudah M, Shetty S, Alomari M, Alqdah M. Acute adult supraglottitis: Current management and treatment. South Med J. 2010;103(8):800-804. doi: 10.1097/SMJ.0b013e3181e538d8.

5. Verbruggen K, Halewyck S, Deron P, Foulon I, Gordts F. Epiglottitis and related complications in adults. Case reports and review of the literature. B-ENT. 2012;8(2):143-148.

6. Mayo-Smith MF, Spinale JW, Donskey CJ, Yukawa M, Li RH, Schiffman FJ. Acute epiglottitis. An 18-year experience in Rhode Island. Chest. 1995;108(6):1640-1647.

7. Bizaki AJ, Numminen J, Vasama JP, Laranne J, Rautiainen M. Acute supraglottitis in adults in Finland: review and analysis of 308 cases. Laryngoscope. 2011;121(10):2107-2113. doi: 10.1002/lary.22147.

8. Charles R, Fadden M, Brook J. Acute epiglottitis. BMJ. 2013;347:f5235. doi: 10.1136/bmj.f5235.

9. Ng HL, Sin LM, Li MF, Que TL, Anandaciva S. Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong. Emerg Med J. 2008;25(5):253-255. doi: 10.1136/emj.2007.050153.

10. Solomon P, Weisbrod M, Irish JC, Gullane PJ. Adult epiglottitis: the Toronto Hospital experience. J Otolaryngol. 1998;27(6):332-336.

11. Schumaker HM, Doris PE, Birnbaum G. Radiographic parameters in adult epiglottitis. Ann Emerg Med. 1984;13(8):588-590.

12. Ko DR, Chung YE, Park I, et al. Use of bedside sonography for diagnosing acute epiglottitis in the emergency department: a preliminary study. J Ultrasound Med. 2012;31(1):19-22.

13. Berger G, Landau T, Berger S, Finkelstein Y, Bernheim J, Ophir D. The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Otolaryngol. 2003;24(6):374-383.

Treatment

The vast majority of adult cases of supraglottitis are managed medically without airway intervention. Patients presenting with a rapid onset of symptoms and in respiratory distress or with stridor, drooling, or cyanosis, should be managed with early airway intervention. The use of corticosteroids is controversial, and has not been proven beneficial in any prospective trials.^1-4,6,7,13

Admission to a critical care unit is indicated initially, even in patients who are not intubated, as they can experience delayed airway compromise with progression of the infection and edema.¹³

Complications

Abscess formation is a serious complication of supraglottitis, is present in up to 30% of cases, and is more likely to be seen in adults than in children.¹³ Since the adult larynx and surrounding tissues are larger than in children, often the infection is present longer, which allows for an abscess to develop. The risk of abscess formation is increased in patients with DM or those in whom a foreign body is present.

Numerous organisms have been isolated from supraglottic abscesses in adults, and in addition to incision and drainage, antibiotics covering both gram-positive organisms and anaerobes should be initiated.⁵ The presence of a supraglottic abscess increases the need for emergent intubation.¹³ In addition, a supraglottic abscess increases the mortality rate to 30%.³ Other complications from supraglottitis include mediastinitis, cervical adenitis, meningitis, and pneumonia.^4,5

Conclusion

While the incidence of epiglottitis in the pediatric patient population has fallen, the incidence in adults remains relatively stable. Clinicians should consider supraglottitis in the differential diagnosis of adults presenting with severe sore throat, dysphagia, or stridor. While airway compromise in adults is uncommon, it does occur. Soft-tissue lateral neck radiographs can help make the diagnosis, but the gold standard remains laryngoscopy. All patients should be started on IV antibiotics and admitted to the ICU initially for airway watch.

Supraglottitis

References

Treatment

Complications

Conclusion

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