Acute Epiglottis

Acute Epiglottis

1. Pathophysiology

   • H. influenzae
     • Unvaccinated populations
   • Streptococcal sp.
   • S. aureus
   • Cocaine

2. Diagnostics

   • Laryngoscopy
   • Thumb Print Signs
     • Soft tissue lateral cervical radiographs: thumb or thumbprint sign (swollen, enlarged epiglottis)

3. Risk Factors

   • Unvaccinated
   • Cocaine use
   • Diabetics

4. Presentation

   • Odynophagia out of proportion to apparently minimal oropharyngeal findings or rapidly developing sore throat
   • The 3 D's
     • Dysphagia
     • Drooling
     • Distress
   • Ondynophagia
     • Fever, inspiratory stridor, dyspnea, hoarseness, muffled “hot potato” voice, tripoding
   • Cherry Red Epiglottis
     • Swollen

5. Management

   • Maintain Clear Airway
     • Keep the patient calm Continuous monitoring of O2 saturation
   • Dexamethasone
     • For airway edema
   • Hospitalization with IV Abx
     • Hospitalization with IV abx  - Second or third gen cephalosporin - Penicillin, ampicillin, or anti-staphylococcal coverage may be added
   • Corticosteroids
     • tapper use as signs and symptoms resolve
   • Indication to Intubate
     • Dyspnea, rapid pace of sore throat where airway may close before effects of abx or corticosteroids kick in, endolaryngeal abscess on CT
   • 10 day course of abx may be appropriate

6. Prevention

   • Rifampin given to all close contacts
   • Hib Vaccine

7. Prognosis

   • Adults
     • Prognosis of adults with acute epiglottitis is good with appropriate and timely treatment. Most pts can be extubated within several days.
     • Unrecognized epiglottitis may rapidly lead to airway compromise and resultant death

8. Complications

   • Meningitis, epiglottic abscess, cervical adenitis, vocal granuloma, subsequent necrotizing fasciitis of the head and neck (rare), cartilaginous metaplasia of the epiglottis, pna, pulmonary edema, empyema, ptx, pneumomediastinum (rare), pericarditits, septic arthritis, cellulitis, septic shock, death (via asphyxiation)