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epiglottitis

Etiology: - Haemophilus influenzae (most common) - MRSA less common Clinical manifestations: 1) sore throat 95% 2) odynophagia 94% 3) muffled voice 54% 4) dyspnea is present in a minority of patients - associated with a higher likelihood of need for endotracheal intubation 5) classic 3Ds: drooling, dysphagia, & distress 6) stridor 7) globus sensation 8) intermittent or variable fever 9) mild tenderness & swelling in the anterior neck (case report) [2] 10) no cervical lymphadenopathy (case report) [2] Special laboratory: - laryngoscopy - erythema & inflammation of the epiglottis & base of tongue - hypertrophy of the lingual tonsil (case report) [2] Radiology: - lateral neck films have a sensitivity of 79% "thumb sign" - CT of the neck: swelling & edema of the epiglottis, base of tongue, & the lingual tonsil (case report) [2] Management: - hospitalization, consider ICU admission with surgical consultation a) airway management - fiberoptic nasotracheal intubation for airway compromise if vocal cords not visualized with preparation for tracheostomy/cricothyrotomy [3] - described as awake fiberoptic intubation [3] - endotracheal intubation or tracheostomy rarely needed b) intravenous antibiotics - 2nd or 3rd generation cephalosporin (ceftriaxone) [2]) - discharge with oral cefuroxime to complete additional 1 week of therapy (case report) [2] - ampicillin sulbactam [3] - include vancomycin if MRSA suspected [3] c) corticosteroids (uncertain benefit) - dexamethasone to reduce risk of airway compromise [2] d) epinephrine (uncertain benefit)

Related

epiglottis pharyngitis

General

laryngitis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11 19, College of Physicians, Philadelphia 1998, 2022
  2. Angirekula V, Multani A. Images in clinical medicine. Epiglottitis in an Adult. N Engl J Med 2015; 372:e20. April 9, 2015. PMID: 25853768 http://www.nejm.org/doi/full/10.1056/NEJMicm1400061
  3. NEJM Knowledge+ Otolaryngology - Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. 2020 Jun 1;67(2):90-97. PMID: 32633776 PMCID: PMC7342809 Free PMC article.