Materiały źródłowe

• #1 Acute epiglottitis: Trends, diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3498669/

  Acute epiglottitis is a life-threatening disorder with serious implications to the anesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. Early diagnosis with careful and rapid intervention of this serious condition is necessary in order to avoid life-threatening complications. […] The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. […] In acute epiglottitis, the radiological thumb sign is indicative of severe inflammation of the epiglottis with potential for irrevocable loss of the airway. […] Patients with signs of an advancing upper airway obstruction, consistent with an acute epiglottitis, should be treated as a medical and an airway emergency. […] Acute epiglottitis is a serious condition necessitating careful and rapid intervention in order to avoid life-threatening complications.

• #2 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. […] Diagnosis requires direct visualization of the supraglottic structures; this procedure is not to be done until full respiratory support is available. […] Epiglottitis is suspected in patients with severe sore throat and no pharyngitis and in patients with sore throat and inspiratory stridor. […] The patient is hospitalized if epiglottitis is suspected. Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] Cultures from the supraglottic tissues and blood can then be taken to search for the causative organism. […] If the diagnosis is suspected, do flexible fiberoptic laryngoscopy in the operating room; reserve imaging tests for cases with very low suspicion.

• #3 Epiglottitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epiglottitis/diagnosis-treatment/drc-20372231

  First, the medical team ensures that the airway is open and that enough oxygen is getting through. The team monitors breathing and blood oxygen levels. […] Oxygen levels that drop too low might need breathing aid. […] Using a flexible fiber-optic-lighted tube, a health care provider looks at the throat through the nose to see what’s causing the symptoms. […] Chest or neck X-ray. They’re not needed for a diagnosis, but X-rays might help providers check if you have epiglottitis. […] Once breathing is stable, a team member wipes the epiglottis with a cotton swab and checks the tissue sample for Hib. […] Blood cultures can find out whether there’s an infection of the blood known as bacteremia. Bacteremia often is present with epiglottitis. […] Antibiotics given through a vein treat epiglottitis. […] The infection needs quick treatment. So, a health care provider might prescribe a broad-spectrum drug right away, rather than waiting for results of the blood and tissue cultures. […] The first medicine may be changed later, depending on what’s causing the epiglottitis.

• #4 Epiglottitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17844-epiglottitis

  Since epiglottitis is a life-threatening medical emergency, healthcare providers usually work through the steps of making a diagnosis only after theyve stabilized your breathing. […] Once youre stable (and only if its perfectly safe), they may run the following tests to diagnose epiglottitis: […] A provider swabs your throat and sends the sample to a pathology lab to test for bacteria or viruses. […] Your provider may perform a variety of blood tests to count your white blood cells (your bodys infection-fighters) or see if there are any bacteria or viruses in your blood. […] A provider uses a small camera at the end of a flexible tube to examine your throat. […] An X-ray can help determine the level of swelling. Epiglottic swelling on an X-ray sometimes resembles an adult thumb. Providers sometimes call this the thumbprint sign.

• #5 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. […] Diagnosis requires direct visualization of the supraglottic structures; this procedure is not to be done until full respiratory support is available. […] Epiglottitis is suspected in patients with severe sore throat and no pharyngitis and in patients with sore throat and inspiratory stridor. […] The patient is hospitalized if epiglottitis is suspected. Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] Cultures from the supraglottic tissues and blood can then be taken to search for the causative organism. […] If the diagnosis is suspected, do flexible fiberoptic laryngoscopy in the operating room; reserve imaging tests for cases with very low suspicion.

• #6 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/ear-nose-and-throat-disorders/mouth-and-throat-disorders/epiglottitis

  Epiglottitis is a bacterial infection of the epiglottis and surrounding tissues. […] Doctors make the diagnosis by looking at the epiglottis with a thin, flexible viewing tube, typically in an operating room. […] Epiglottitis is suspected in people with a severe sore throat and stridor or other symptoms of epiglottitis if their throat appears normal. If doctors suspect epiglottitis, the person is hospitalized. […] Doctors diagnose epiglottitis by looking at the epiglottis with a thin, flexible viewing tube (laryngoscope), typically in an operating room. […] Samples of blood or tissues around the epiglottis may be cultured (sent to a laboratory to try to grow bacteria) to identify the bacteria causing the infection.

• #7 Epiglottitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/452

  Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken. […] Diagnosis is made on clinical grounds, and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected. […] Pertinent diagnostic criteria include the classic „tripod” position of the patient, drooling, high fever, and a toxic appearance. […] Key diagnostic factors include nonvaccination with Hib vaccine, sore throat, dysphagia, difficulty in controlling secretions, toxic appearance, acute distress, fever, tripod position, and difficulty breathing. […] 1st tests to order include laryngoscopy and erect lateral neck radiograph. […] Tests to consider include complete blood count and cultures of blood/supraglottis (epiglottis).

• #8 Epiglottitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000605.htm

  Epiglottitis can be a medical emergency. Seek medical help right away. Do not use anything to press the tongue down to try to look at the throat at home. Doing so may make the condition worse. […] The health care provider may examine the voice box (larynx) using a small mirror held against the back of the throat. Or a viewing tube called a laryngoscope may be used. This examination is best done in the operating room or a similar setting where sudden breathing problems can be more easily handled. […] Tests that may be done include: Blood culture or throat culture, Complete blood count (CBC), Neck x-ray.

• #9 Epiglottitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/452

  Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken. […] Diagnosis is made on clinical grounds, and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected. […] Pertinent diagnostic criteria include the classic „tripod” position of the patient, drooling, high fever, and a toxic appearance. […] Key diagnostic factors include nonvaccination with Hib vaccine, sore throat, dysphagia, difficulty in controlling secretions, toxic appearance, acute distress, fever, tripod position, and difficulty breathing. […] 1st tests to order include laryngoscopy and erect lateral neck radiograph. […] Tests to consider include complete blood count and cultures of blood/supraglottis (epiglottis).

• #10 Epiglottitis physical examination – wikidoc

  https://www.wikidoc.org/index.php/Epiglottitis_physical_examination

  On physical examination, patients with epiglottitis may present with the following: […] Patients with epiglottitis especially children may adapt the so called tripod posture with hyper-extension of the neck, chin pointing forward and trunk and arms leaning forward. […] High temperature […] Inflammed epiglottis […] Pharyngeal redness […] Tenderness of anterior neck […] Cervical lymphadenopathy […] May be in obvious respiratory distress with flaring of ala nasi, subcostal and intercostal recessions. […] Increased respiratory rate in both children and adults […] Decreased air-entry depending of degree of airway obstruction […] Cyanosis.

• #11 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. […] Diagnosis requires direct visualization of the supraglottic structures; this procedure is not to be done until full respiratory support is available. […] Epiglottitis is suspected in patients with severe sore throat and no pharyngitis and in patients with sore throat and inspiratory stridor. […] The patient is hospitalized if epiglottitis is suspected. Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] Cultures from the supraglottic tissues and blood can then be taken to search for the causative organism. […] If the diagnosis is suspected, do flexible fiberoptic laryngoscopy in the operating room; reserve imaging tests for cases with very low suspicion.

• #12 Epiglottitis Workup: Approach Considerations, Nasopharyngoscopy/Laryngoscopy, Radiography

  https://emedicine.medscape.com/article/763612-workup

  Airway management is the most urgent consideration, and patients should first be assessed for level of distress before any other workup. […] Radiographic evaluation for suspected epiglottitis is being replaced by direct visualization of the epiglottis using nasopharyngoscopy/laryngoscopy as the preferred method of diagnosis. Only 79% of epiglottis cases are diagnosed by neck soft-tissue radiographs, underscoring the importance of direct visualization by fiberoptic endoscopy in obtaining a timely and accurate diagnosis. […] Direct visualization of the epiglottis using nasopharyngoscopy/laryngoscopy is the preferred method of diagnosis and is replacing radiographic evaluation for suspected epiglottitis. The airway should be secured or should be readily securable if endoscopy is performed.

• #13

  https://journals.lww.com/jcsr/fulltext/2020/09020/acute_epiglottitis___a_life_threatening_clinical.8.aspx

  Acute epiglottitis (AE) is an acute inflammatory life-threatening clinical condition which can lead to obstruction of the airway. […] Clinical presentations are alone insufficient for the diagnosis of AE. Fibreoptic nasopharyngolaryngoscopic examination should be performed as soon as possible for confirmation of diagnosis. […] The diagnosis of AE is based on clinical presentation supported by laryngoscopic examination. Typically, there is classic cherry-red appearance of the epiglottis along with swelling of the AEFs in indirect laryngoscopic examination. […] Laryngoscopy is considered to be the standard method for the diagnosis of AE and should be done in all cases of AE. […] The findings of AE have vallecula sign, the thumb sign, thickened AEFs, enlargement of the widening of the soft tissue and ballooning of the hypopharynx. […] Blood cultures can be done by taking blood taken from patients of AE to confirm the bacteriological agent. […] The diagnosis of AE is essential based on the clinical findings and supported by indirect laryngoscopy.

• #14 Epiglottitis | Ento Key

  https://entokey.com/epiglottitis-3/

  Epiglottitis is an acute inflammatory condition of the epiglottis and supraglottic structures that can quickly progress to fatal airway obstruction. […] The diagnosis of epiglottitis is clinical, and direct inspection on endoscopy is the gold standard for definitive diagnosis. Edema and erythema of the epiglottis, arytenoids, and aryepiglottic fold are the most common findings. […] If flexible laryngoscopy is not readily available, imaging studies can aid in making the diagnosis and determining the need for airway intervention. Lateral neck films are low-cost and easily obtained. Radiographic features suggestive of epiglottitis include the thumb sign, vallecula sign, thickened aryepiglottic folds, and hypopharyngeal distention. […] According to two studies, an epiglottic width greater than 5 mm, especially when measured at the base of epiglottis, is the most accurate objective parameter.

• #15 Epiglottitis: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/epiglottitis-pro

  Epiglottitis is a life-threatening condition and a high index of suspicion is required. Any patients, of any age, with a severe sore throat, not tolerating oral fluids, should be referred for urgent assessment. […] Diagnosis in adults can be difficult, as they may not have signs of respiratory distress (stridor). Patients with a significant sore throat with no obvious aetiology should be referred to ENT for direct visualisation of their larynx by flexible laryngoscopy. More than 90% of epiglottitis patients will have a normal oropharyngeal cavity and the diagnosis should be suspected when the severity of the epiglottitis symptoms does not correlate with the findings on examination. […] Patients who are suspected of having acute epiglottitis should not have their throat examined with the aid of a tongue depressor, due to the risk of laryngeal obstruction; rather, they should be urgently referred for laryngoscopy.

• #16 Epiglottitis: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/epiglottitis-pro

  Fibre-optic laryngoscopy remains the 'gold standard’ for diagnosing epiglottitis, as the epiglottis can be seen directly. Laryngoscopy in these patients should only be performed in areas such as operating theatres which are prepared for intubation or tracheostomy in the event of upper airway obstruction.

• #17 Epiglottitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430960/

  Epiglottitis is a rare inflammatory condition that affects the epiglottis and nearby structures in the upper part of the throat, including the arytenoid soft tissue, aryepiglottic folds, valleculae, base of the tongue, soft palate, and uvula. […] Due to its various presentations, the diagnosis of epiglottitis can pose significant challenges. […] In this activity, healthcare professionals learn to recognize the clinical features of epiglottitis, accurately evaluate the condition, and apply evidence-based management strategies. […] Apply the latest diagnostic tools and imaging techniques to confirm epiglottitis and rule out other conditions. […] The diagnosis is clinically based, and the evaluation should be delayed to secure the airway. […] Adult epiglottitis evaluation may differ if urgent airway control is not warranted.

• #18 Epiglottitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430960/

  The classic lateral neck radiograph should never be obtained without definitive airway control, and no child should be left unattended to acquire imaging. […] Adult mortality from epiglottitis can reach 7% to 10%, which is much higher than in children. […] No consensus exists on the optimal management of adult epiglottitis due to varying clinical presentations, healthcare settings, expertise, and resources.

• #19 Acute Epiglottitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/408662-overview

  Epiglottitis is a rapidly developing inflammation of the epiglottis and adjacent tissues, usually due to a bacterial infection, that can cause life-threatening airway obstruction. […] Findings on lateral neck radiographs are frequently diagnostic. A single, lateral, upright view of the neck in extension, preferably with a closed mouth, is usually adequate. […] Direct visualization of the epiglottis using nasopharyngoscopy/laryngoscopy is the preferred method of diagnosis, and radiographs are not required when the diagnosis can be made by history and physical examination alone or with direct visualization. […] The use of computed tomography (CT) scanning is risky in the diagnosis of epiglottitis, but it may help in the evaluation of complications, such as abscess formation. […] Widespread use of ultrasonography in the ED has led to its use in the diagnosis of acute epiglottitis.

• #20 Acute Epiglottitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/408662-overview

  Soft-tissue, lateral neck radiography has a sensitivity of 88-100% and a specificity of 87-96% in diagnosing epiglottitis. […] An enlarged epiglottis may result from various disorders, including irritation from a foreign body or burn, granulomatous disease (eg, sarcoidosis, tuberculosis, Wegener granulomatosis), angioneurotic edema, and tumors, such as epiglottic cysts and neoplasms (eg, lymphomas). […] The most common CT scan findings include thickening of the epiglottis, aryepiglottic folds, platysma muscle, and prevertebral fascia; obliteration of the pre-epiglottic fat planes; and reticulation of the subcutaneous fat. […] As with CT scanning, magnetic resonance imaging (MRI) is not recommended for initial diagnosis but may be useful for excluding potential mimickers of epiglottitis or for identifying complications. […] Ultrasound may facilitate exclusion of other diseases, such as peritonsillar abscess, and can help determine results of treatment.

• #21 Acute Epiglottitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/408662-overview

  Soft-tissue, lateral neck radiography has a sensitivity of 88-100% and a specificity of 87-96% in diagnosing epiglottitis. […] An enlarged epiglottis may result from various disorders, including irritation from a foreign body or burn, granulomatous disease (eg, sarcoidosis, tuberculosis, Wegener granulomatosis), angioneurotic edema, and tumors, such as epiglottic cysts and neoplasms (eg, lymphomas). […] The most common CT scan findings include thickening of the epiglottis, aryepiglottic folds, platysma muscle, and prevertebral fascia; obliteration of the pre-epiglottic fat planes; and reticulation of the subcutaneous fat. […] As with CT scanning, magnetic resonance imaging (MRI) is not recommended for initial diagnosis but may be useful for excluding potential mimickers of epiglottitis or for identifying complications. […] Ultrasound may facilitate exclusion of other diseases, such as peritonsillar abscess, and can help determine results of treatment.

• #22 Death After Delayed Diagnosis of Acute Epiglottitis in an Adult Patient Initially Seen in Urgent Care: A Case Report – Journal of Urgent Care Medicine

  https://www.jucm.com/death-after-delayed-diagnosis-of-acute-epiglottitis-in-an-adult-patient-initially-seen-in-urgent-care-a-case-report/

  Early signs and symptoms of acute epiglottitis overlap with those of many common self-limited conditions frequently seen in UC. However, because early recognition of epiglottitis is critical for preventing poor outcomes, as the patient in this case experienced, concerning findings during the initial assessment must not be overlooked. […] The thumbprint sign is not seen in approximately 23% of presentations; the subjective nature of this finding and its frequent absence early in the disease course functionally limit its clinical utility. […] In cases where clinical suspicion is present but low, it is generally appropriate to obtain soft tissue neck radiographs in UC. If there are suggestive findings of epiglottitis on lateral neck XR (eg, thumbprint sign or widening of the base of the epiglottis) and/or progression of symptoms during the patients UC course, EMS activation is indicated.

• #23 Epiglottitis – EMCrit Project

  https://emcrit.org/ibcc/epiglottitis/

  diagnosis […] Findings […] Swollen epiglottis may be seen as a thumb sign (normally, epiglottis profile should look like a finger). […] Obliteration of the vallecula (vallecula sign) may be seen […] Performance? ~88% sensitive, so a negative X-ray doesn’t exclude epiglottitis. […] Roles of CT scan: [1] Diagnosis of epiglottitis. Contrasted CT scan of the neck has a sensitivity of 88-100% and specificity of ~96% for epiglottitis. […] Flexible fiberoptic exam allows visualization of the larynx at the bedside. […] This may be preferable for a tenuous patient, since it doesn’t require transportation out of the department. […] In addition to diagnosing epiglottitis, nasolaryngoscopy should provide additional information about the airway (How much airway compromise is there? How difficult or easy would it be to intubate the patient?).

• #24

  https://journals.lww.com/jcsr/fulltext/2020/09020/acute_epiglottitis___a_life_threatening_clinical.8.aspx

  Acute epiglottitis (AE) is an acute inflammatory life-threatening clinical condition which can lead to obstruction of the airway. […] Clinical presentations are alone insufficient for the diagnosis of AE. Fibreoptic nasopharyngolaryngoscopic examination should be performed as soon as possible for confirmation of diagnosis. […] The diagnosis of AE is based on clinical presentation supported by laryngoscopic examination. Typically, there is classic cherry-red appearance of the epiglottis along with swelling of the AEFs in indirect laryngoscopic examination. […] Laryngoscopy is considered to be the standard method for the diagnosis of AE and should be done in all cases of AE. […] The findings of AE have vallecula sign, the thumb sign, thickened AEFs, enlargement of the widening of the soft tissue and ballooning of the hypopharynx. […] Blood cultures can be done by taking blood taken from patients of AE to confirm the bacteriological agent. […] The diagnosis of AE is essential based on the clinical findings and supported by indirect laryngoscopy.

• #25 Epiglottitis – EMCrit Project

  https://emcrit.org/ibcc/epiglottitis/

  diagnosis […] Findings […] Swollen epiglottis may be seen as a thumb sign (normally, epiglottis profile should look like a finger). […] Obliteration of the vallecula (vallecula sign) may be seen […] Performance? ~88% sensitive, so a negative X-ray doesn’t exclude epiglottitis. […] Roles of CT scan: [1] Diagnosis of epiglottitis. Contrasted CT scan of the neck has a sensitivity of 88-100% and specificity of ~96% for epiglottitis. […] Flexible fiberoptic exam allows visualization of the larynx at the bedside. […] This may be preferable for a tenuous patient, since it doesn’t require transportation out of the department. […] In addition to diagnosing epiglottitis, nasolaryngoscopy should provide additional information about the airway (How much airway compromise is there? How difficult or easy would it be to intubate the patient?).

• #26 Epiglottitis – EMCrit Project

  https://emcrit.org/ibcc/epiglottitis/

  Positive in ~25% of cases. […] May assist in narrowing antibiotics. […] May be identified on CT scan of the neck or nasolaryngoscopy. […] There is no definitive evidence regarding how to manage epiglottic abscess. […] One tiny RCT found that abscess drainage under local anesthesia in awake patients reduced the hospital length of stay. […] Likewise, another small series reported that pre-emptive abscess drainage without intubation was feasible. […] In retrospective studies, abscess was associated with 27% likelihood of requiring airway intervention. […] Bottom line? Don’t assume that an abscess necessarily mandates drainage or intubation (many patients may respond to medical therapy alone). […] Consult ENT surgery regarding optimal management.

• #27 Acute Epiglottitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/408662-overview

  Soft-tissue, lateral neck radiography has a sensitivity of 88-100% and a specificity of 87-96% in diagnosing epiglottitis. […] An enlarged epiglottis may result from various disorders, including irritation from a foreign body or burn, granulomatous disease (eg, sarcoidosis, tuberculosis, Wegener granulomatosis), angioneurotic edema, and tumors, such as epiglottic cysts and neoplasms (eg, lymphomas). […] The most common CT scan findings include thickening of the epiglottis, aryepiglottic folds, platysma muscle, and prevertebral fascia; obliteration of the pre-epiglottic fat planes; and reticulation of the subcutaneous fat. […] As with CT scanning, magnetic resonance imaging (MRI) is not recommended for initial diagnosis but may be useful for excluding potential mimickers of epiglottitis or for identifying complications. […] Ultrasound may facilitate exclusion of other diseases, such as peritonsillar abscess, and can help determine results of treatment.

• #28 Acute Epiglottitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/408662-overview

  Soft-tissue, lateral neck radiography has a sensitivity of 88-100% and a specificity of 87-96% in diagnosing epiglottitis. […] An enlarged epiglottis may result from various disorders, including irritation from a foreign body or burn, granulomatous disease (eg, sarcoidosis, tuberculosis, Wegener granulomatosis), angioneurotic edema, and tumors, such as epiglottic cysts and neoplasms (eg, lymphomas). […] The most common CT scan findings include thickening of the epiglottis, aryepiglottic folds, platysma muscle, and prevertebral fascia; obliteration of the pre-epiglottic fat planes; and reticulation of the subcutaneous fat. […] As with CT scanning, magnetic resonance imaging (MRI) is not recommended for initial diagnosis but may be useful for excluding potential mimickers of epiglottitis or for identifying complications. […] Ultrasound may facilitate exclusion of other diseases, such as peritonsillar abscess, and can help determine results of treatment.

• #29 Epiglottitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/epiglottitis?lang=us

  Epiglottitis, also known as supraglottitis, is a life-threatening condition caused by inflammation of the epiglottis and aryepiglottic folds, which can lead to acute airway obstruction. […] Acute epiglottitis is potentially life threatening due to the risk of airway obstruction, particularly in children. The adult form tends to have a lower risk of airway obstruction due to the larger size of the adult airway and better tolerance of supraglottic edema. […] CT is only rarely obtained, and usually when the diagnosis is unclear. Indeed, placing the child in the supine position can actually precipitate respiratory arrest. If a scan is obtained, marked edema and thickening of the epiglottis and aryepiglottic folds may be seen with narrowing of the airway. […] Treatment must be expeditious given the life-threatening nature of the condition.

• #30 Epiglottitis – Larynx Diseases – Respirology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.3.24.

  A lateral neck radiograph may show thickening of the epiglottis (the thumb sign). However, this finding is not pathognomonic of epiglottitis. The gold-standard investigation remains fiberoptic visualization. Suspicious clinical findings require further investigation with fiberoptic endoscopy regardless of the results of lateral neck radiography. […] […] Complete blood count, electrolytes. […] […] Chest radiographs are performed to exclude concomitant intrathoracic problems. […] […] A contrast-enhanced CT scan of the neck can be useful to exclude the possibility of a deep neck abscess, especially in patients whose infection fails to respond to standard intravenous antibiotics or who have significant restriction of neck movement. It should only be ordered in patients stable enough to be transferred to the radiology department.

• #31 Acute Epiglottitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/408662-overview

  Epiglottitis is a rapidly developing inflammation of the epiglottis and adjacent tissues, usually due to a bacterial infection, that can cause life-threatening airway obstruction. […] Findings on lateral neck radiographs are frequently diagnostic. A single, lateral, upright view of the neck in extension, preferably with a closed mouth, is usually adequate. […] Direct visualization of the epiglottis using nasopharyngoscopy/laryngoscopy is the preferred method of diagnosis, and radiographs are not required when the diagnosis can be made by history and physical examination alone or with direct visualization. […] The use of computed tomography (CT) scanning is risky in the diagnosis of epiglottitis, but it may help in the evaluation of complications, such as abscess formation. […] Widespread use of ultrasonography in the ED has led to its use in the diagnosis of acute epiglottitis.

• #32 Epiglottitis – Wikipedia

  https://en.wikipedia.org/wiki/Epiglottitis

  Diagnosis may be confirmed by direct inspection using a laryngoscope, although this may provoke airway spasm. If epiglottitis is suspected, attempts to visualize the epiglottis using a tongue depressor are discouraged for this reason; therefore, diagnosis is made on basis of indirect fiberoptic laryngoscopy carried out in a controlled environment like an operating room. An infected epiglottis appears swollen and is described as having a „cherry-red” appearance. Imaging is rarely useful, and treatment should not be delayed for this test to be carried out. […] On lateral C-spine X-ray, the thumbprint sign describes a swollen, enlarged epiglottis. A normal X-ray, however, does not exclude the diagnosis. An ultrasound may be helpful if specific changes are present, but its use (as of 2018) is in the early stages of study.

• #33 Acute Epiglottitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/408662-overview

  Soft-tissue, lateral neck radiography has a sensitivity of 88-100% and a specificity of 87-96% in diagnosing epiglottitis. […] An enlarged epiglottis may result from various disorders, including irritation from a foreign body or burn, granulomatous disease (eg, sarcoidosis, tuberculosis, Wegener granulomatosis), angioneurotic edema, and tumors, such as epiglottic cysts and neoplasms (eg, lymphomas). […] The most common CT scan findings include thickening of the epiglottis, aryepiglottic folds, platysma muscle, and prevertebral fascia; obliteration of the pre-epiglottic fat planes; and reticulation of the subcutaneous fat. […] As with CT scanning, magnetic resonance imaging (MRI) is not recommended for initial diagnosis but may be useful for excluding potential mimickers of epiglottitis or for identifying complications. […] Ultrasound may facilitate exclusion of other diseases, such as peritonsillar abscess, and can help determine results of treatment.

• #34 Epiglottitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epiglottitis/diagnosis-treatment/drc-20372231

  First, the medical team ensures that the airway is open and that enough oxygen is getting through. The team monitors breathing and blood oxygen levels. […] Oxygen levels that drop too low might need breathing aid. […] Using a flexible fiber-optic-lighted tube, a health care provider looks at the throat through the nose to see what’s causing the symptoms. […] Chest or neck X-ray. They’re not needed for a diagnosis, but X-rays might help providers check if you have epiglottitis. […] Once breathing is stable, a team member wipes the epiglottis with a cotton swab and checks the tissue sample for Hib. […] Blood cultures can find out whether there’s an infection of the blood known as bacteremia. Bacteremia often is present with epiglottitis. […] Antibiotics given through a vein treat epiglottitis. […] The infection needs quick treatment. So, a health care provider might prescribe a broad-spectrum drug right away, rather than waiting for results of the blood and tissue cultures. […] The first medicine may be changed later, depending on what’s causing the epiglottitis.

• #35 Epiglottitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17844-epiglottitis

  Since epiglottitis is a life-threatening medical emergency, healthcare providers usually work through the steps of making a diagnosis only after theyve stabilized your breathing. […] Once youre stable (and only if its perfectly safe), they may run the following tests to diagnose epiglottitis: […] A provider swabs your throat and sends the sample to a pathology lab to test for bacteria or viruses. […] Your provider may perform a variety of blood tests to count your white blood cells (your bodys infection-fighters) or see if there are any bacteria or viruses in your blood. […] A provider uses a small camera at the end of a flexible tube to examine your throat. […] An X-ray can help determine the level of swelling. Epiglottic swelling on an X-ray sometimes resembles an adult thumb. Providers sometimes call this the thumbprint sign.

• #36 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-epiglottitis.aspx

  Routine blood examination is usually prescribed. Hallmarks of infection include raised white blood cell count. […] Blood culture for Haemophilus influenza, H parainfluenzae, Streptococcus pneumoniae, and group A streptococci may be performed to confirm the organism causing the epiglottitis. […] A swab is used to swipe the mucus over the back of the neck. […] Computed tomography (CT) scanning of the neck in early or unusual cases may be prescribed.

• #37 Epiglottitis Workup: Approach Considerations, Nasopharyngoscopy/Laryngoscopy, Radiography

  https://emedicine.medscape.com/article/763612-workup

  Blood cultures may be taken, particularly if the patient is systemically unwell. The cultures are positive in approximately 25% of adult cases. Given the relatively large number of infectious agents besides H influenzae type b and Streptococcus species that may cause adult epiglottitis, blood culture and sensitivities may be particularly helpful in this population.

• #38 More Than a Sore Throat: Acute Epiglottitis — Taming the SRU

  https://www.tamingthesru.com/blog/minor-care-series/more-than-a-sore-throat-acute-epiglottitis

  Laboratory studies typically show a leukocytosis and elevated inflammatory markers such as C-Reactive Protein (CRP). Obtaining blood cultures early in the clinical course of these patients can help tailor antibiotics to the appropriate causative organism and therefore should be ordered as part of the patients initial workup. […] Soft tissue neck radiographs may also be helpful in aiding with diagnosis, however are not required in patients of which you have a high clinical suspicion of epiglottis. […] If soft tissue neck radiographs are equivocal and there is concern for possibility of retropharyngeal abscess, CT imaging of the neck can be used to further delineate the cause of the patients presentation. […] Managing the airway is of the utmost importance in patients with epiglottitis.

• #39 Epiglottitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epiglottitis/diagnosis-treatment/drc-20372231

  First, the medical team ensures that the airway is open and that enough oxygen is getting through. The team monitors breathing and blood oxygen levels. […] Oxygen levels that drop too low might need breathing aid. […] Using a flexible fiber-optic-lighted tube, a health care provider looks at the throat through the nose to see what’s causing the symptoms. […] Chest or neck X-ray. They’re not needed for a diagnosis, but X-rays might help providers check if you have epiglottitis. […] Once breathing is stable, a team member wipes the epiglottis with a cotton swab and checks the tissue sample for Hib. […] Blood cultures can find out whether there’s an infection of the blood known as bacteremia. Bacteremia often is present with epiglottitis. […] Antibiotics given through a vein treat epiglottitis. […] The infection needs quick treatment. So, a health care provider might prescribe a broad-spectrum drug right away, rather than waiting for results of the blood and tissue cultures. […] The first medicine may be changed later, depending on what’s causing the epiglottitis.

• #40 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. […] Diagnosis requires direct visualization of the supraglottic structures; this procedure is not to be done until full respiratory support is available. […] Epiglottitis is suspected in patients with severe sore throat and no pharyngitis and in patients with sore throat and inspiratory stridor. […] The patient is hospitalized if epiglottitis is suspected. Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] Cultures from the supraglottic tissues and blood can then be taken to search for the causative organism. […] If the diagnosis is suspected, do flexible fiberoptic laryngoscopy in the operating room; reserve imaging tests for cases with very low suspicion.

• #41 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-epiglottitis.aspx

  Epiglottitis, or infection and inflammation of the epiglottis, is mainly caused by Haemophilus influenza type b and commonly affects children between ages 2 and 7 and adults with a depressed immune system. […] Diagnosis relies on clinical judgement and examination primarily since time is of utmost importance. […] Bedside evaluation and certain diagnostic procedures are suggested. These are essential to rule out other conditions that may mimic epiglottitis. […] Investigative procedures should be performed after airway is secured and patient is stable. Investigative procedures that confirm the diagnosis include (1-5): […] X ray of the neck. This shows the swollen and inflamed epiglottis when taken from the side. […] Visualization of the inflamed epiglottis via nasopharyngoscopy or laryngoscopy.

• #42 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-epiglottitis.aspx

  Routine blood examination is usually prescribed. Hallmarks of infection include raised white blood cell count. […] Blood culture for Haemophilus influenza, H parainfluenzae, Streptococcus pneumoniae, and group A streptococci may be performed to confirm the organism causing the epiglottitis. […] A swab is used to swipe the mucus over the back of the neck. […] Computed tomography (CT) scanning of the neck in early or unusual cases may be prescribed.

• #43 Epiglottitis differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Epiglottitis_differential_diagnosis

  Epiglottitis must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction examples: Croup (Laryngotracheobronchitis), Foreign body obstruction, Subglottic stenosis, pharyngitis, tonsilitis, angioedema, uvulitis, retropharyngeal or peritonsilar abscesses and bacterial tracheitis. For example, although patients with croup and epiglottitis both have stridor, in epiglottitis there is associated drooling without a cough whereas in croup there is cough but no drooling. […] Epiglottitis must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction. […] Some similarities and differences between these differentials are shown below: […] Physical exams findings include suprasternal and intercostal indrawing, inspiratory stridor, expiratory wheezing, sternal wall retractions, cyanosis, cervical lymphadenopathy, and inflamed epiglottis.

• #44 Epiglottitis: Causes, Symptoms, Diagnosis and Treatment

  https://www.webmd.com/a-to-z-guides/epiglottitis-infection-inflammation

  They’ll also run tests to find out what’s causing the inflection. That may include: Blood tests, Throat swab. […] Despite modern technology, epiglottitis is not easy to diagnose. It’s often mistaken for strep throat or croup. […] Both epiglottitis and croup can cause hoarseness and a whistling sound when you breathe. But croup tends to affect younger children and come on more gradually than epiglottitis does. Croup causes swelling farther down in your respiratory system, below your epiglottis, and brings on a distinctive barking cough. It doesn’t usually cause drooling or trouble swallowing. […] Other conditions epiglottitis may be confused with include: Diphtheria, An abscess (pocket of pus) in your tonsils or back of your throat, Angioedema (swelling from an allergic reaction).

• #45 Epiglottitis: Causes, Treatment, Symptoms, vs. Croup & Diagnosis

  https://www.emedicinehealth.com/epiglottitis/article_em.htm

  It is often easy to mistake epiglottitis for croup. Epiglottitis differs clinically from croup by its progressive worsening, lack of a barking cough, and a cherry red swollen epiglottis versus a red/pink, nonswollen epiglottis in croup. One way doctors can tell epiglottitis from croup is with X-rays of the neck.

• #46 Epiglottitis – EMCrit Project

  https://emcrit.org/ibcc/epiglottitis/

  Positive in ~25% of cases. […] May assist in narrowing antibiotics. […] May be identified on CT scan of the neck or nasolaryngoscopy. […] There is no definitive evidence regarding how to manage epiglottic abscess. […] One tiny RCT found that abscess drainage under local anesthesia in awake patients reduced the hospital length of stay. […] Likewise, another small series reported that pre-emptive abscess drainage without intubation was feasible. […] In retrospective studies, abscess was associated with 27% likelihood of requiring airway intervention. […] Bottom line? Don’t assume that an abscess necessarily mandates drainage or intubation (many patients may respond to medical therapy alone). […] Consult ENT surgery regarding optimal management.

• #47 Epiglottitis – Wikipedia

  https://en.wikipedia.org/wiki/Epiglottitis

  If there is visual or radiologic evidence that the infection has caused tissue destruction, the disease is called „necrotizing epiglottitis” (NE). The feared complication of NE is the bacteria spreading to the surrounding neck muscles and causing cervical necrotizing fasciitis which is a surgical emergency.

• #48 Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

  https://www.mdpi.com/2075-4418/12/1/29

  Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. […] Acute epiglottitis (AE) is a bacterial infection of supraglottic structures that results in a symptom complex consisting of a sore throat, stridor, odynophagia, muffled voice, and a high fever; it is a potentially life-threatening condition secondary to airway obstruction. […] Previous studies showed that some patients may present with concurrent DNI and AE. […] This study was therefore performed to investigate the risk factors in patients with concurrent DNI and AE.

• #49 Epiglottitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430960/

  The classic lateral neck radiograph should never be obtained without definitive airway control, and no child should be left unattended to acquire imaging. […] Adult mortality from epiglottitis can reach 7% to 10%, which is much higher than in children. […] No consensus exists on the optimal management of adult epiglottitis due to varying clinical presentations, healthcare settings, expertise, and resources.

• #50 Epiglottitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17844-epiglottitis

  Since epiglottitis is a life-threatening medical emergency, healthcare providers usually work through the steps of making a diagnosis only after theyve stabilized your breathing. […] Once youre stable (and only if its perfectly safe), they may run the following tests to diagnose epiglottitis: […] A provider swabs your throat and sends the sample to a pathology lab to test for bacteria or viruses. […] Your provider may perform a variety of blood tests to count your white blood cells (your bodys infection-fighters) or see if there are any bacteria or viruses in your blood. […] A provider uses a small camera at the end of a flexible tube to examine your throat. […] An X-ray can help determine the level of swelling. Epiglottic swelling on an X-ray sometimes resembles an adult thumb. Providers sometimes call this the thumbprint sign.

• #51 Adult Epiglottitis | American Journal of Neuroradiology

  https://www.ajnr.org/ajnr-case-collections-diagnosis/adult-epiglottitis

  Adult epiglottitis is a rare entity, with some authors believing that the incidence may be rising. […] Although traditionally considered as a pediatric disease, this entity can be encountered in adults, where pathogens other than H. influenzae type B may cause epiglottitis, including Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and Klebsiella pneumoniae. […] Risk factors for worse prognosis include diabetes mellitus, older age, high BMI, and an immunocompromised host. […] Due to the indolent course, this entity can be misdiagnosed as an upper respiratory infection. […] Edema of the epiglottis, hypopharynx, and supraglottic larynx are the most common features. These findings may lead to airway obstruction. Reactive but usually non-necrotic lymph nodes may be seen. […] Empirical antibiotics are recommended, with urgent ENT consultation for airway management. The incidence of airway compromise is lower than in the pediatric population but can be as high as 21%.

• #52 Epiglottitis – TeachMePaediatrics

  https://teachmepaediatrics.com/ent/throat/epiglottitis/

  Acute epiglottitis is an acute, life-threatening condition, most commonly caused by infection. This article will look at the epidemiology, pathophysiology, clinical features, differential diagnoses, investigations and management of epiglottitis. […] The airway must be secured before considering further investigation. Children with epiglottitis have a high risk of obstructing their airway if agitated so shouldn’t be examined or undergo unnecessary observations which could exacerbate this. It is important to keep the environment calm, allow the child to remain with their parent, avoid the supine position and aim to visualise the epiglottis in theatre. Intubation equipment should always be nearby as these children are prone to acute deterioration. […] Both bacterial and viral swabs should be taken on intubation to aid diagnosis and guide management.

• #53 Pulsenotes | Acute epiglottitis notes

  https://app.pulsenotes.com/specialities/paediatrics/notes/acute-epiglottitis

  Acute epiglottitis requires rapid assessment and clinical diagnosis to prevent further airway compromise. […] Diagnosis is based on visualisation of the inflamed epiglottis, however, this should only be attempted by a clinician who is trained to deal with the airway. […] There is concern that attempts to visualise the back of the throat by an untrained clinician could lead to cardiorespiratory arrest by a variety of mechanisms (e.g. functional obstruction, laryngospasm). Therefore, if a child has classical signs of epiglottitis prompt involvement of a clinician with paediatric airway skills is needed before visualisation. This is so the airway can be secured if deterioration during, or after, visualisation occurs. […] The initial priority is airway management. Subsequent investigations may include blood tests, blood cultures, epiglottic cultures (only if airway secure), or imaging. Imaging may have a role (e.g. MRI/CT for suspected abscess). Lateral radiographs of the neck can be used to look for oedema of the epiglottis (the classic 'thumb sign’), but direct visualisation is the standard of care.

• #54 Acute epiglottitis: Trends, diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3498669/

  Acute epiglottitis is a life-threatening disorder with serious implications to the anesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. Early diagnosis with careful and rapid intervention of this serious condition is necessary in order to avoid life-threatening complications. […] The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. […] In acute epiglottitis, the radiological thumb sign is indicative of severe inflammation of the epiglottis with potential for irrevocable loss of the airway. […] Patients with signs of an advancing upper airway obstruction, consistent with an acute epiglottitis, should be treated as a medical and an airway emergency. […] Acute epiglottitis is a serious condition necessitating careful and rapid intervention in order to avoid life-threatening complications.

• #55 Death After Delayed Diagnosis of Acute Epiglottitis in an Adult Patient Initially Seen in Urgent Care: A Case Report – Journal of Urgent Care Medicine

  https://www.jucm.com/death-after-delayed-diagnosis-of-acute-epiglottitis-in-an-adult-patient-initially-seen-in-urgent-care-a-case-report/

  Epiglottitis is a potentially fatal condition that has undergone a changing etiology in the post-Hib vaccine landscape. […] Accurate and timely identification remains the best route to epiglottitis diagnosis and management. […] The gold standard for diagnosis of acute epiglottitis is visualization of an inflamed and enlarged epiglottis on direct or video laryngoscopy. […] A presumptive diagnosis, however, is often arrived upon prior to laryngoscopy based on a combination of clinical and/or imaging findings. […] In cases of suspected or confirmed acute epiglottitis, ensuring airway patency is the top priority, often by means of endotracheal intubation. […] Given that invasive airway management maneuvers are not feasible in the UC setting, patients with signs or symptoms strongly suggestive of acute epiglottitis should be immediately transferred to an ED by emergency medical services (EMS).

• #56 Epiglottitis Misdiagnosis and Delayed Treatment: A Legal Perspective – Lupetin & Unatin, LLC

  https://www.pamedmal.com/epiglottitis-misdiagnosis-and-delayed-treatment-a-legal-perspective/

  Epiglottitis is a serious, potentially life-threatening condition characterized by the rapid inflammation and swelling of the epiglottis, which is a small cartilage lid that covers the windpipe (trachea) to prevent food from entering the airway during swallowing. This condition is most commonly caused by a bacterial infection, but can also result from other factors like injury or inflammation. Medical malpractice claims arise when epiglottitis is not diagnosed or treated in time. […] Prompt diagnosis and treatment are critical in managing epiglottitis. The treatment primarily focuses on securing the airway and addressing the underlying infection. […] Epiglottitis requires emergency medical care, and delays in treatment can lead to rapid deterioration and severe outcomes. Early medical intervention significantly improves the prognosis and reduces the risk of serious complications.

• #57 Epiglottitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430960/

  The classic lateral neck radiograph should never be obtained without definitive airway control, and no child should be left unattended to acquire imaging. […] Adult mortality from epiglottitis can reach 7% to 10%, which is much higher than in children. […] No consensus exists on the optimal management of adult epiglottitis due to varying clinical presentations, healthcare settings, expertise, and resources.

• #58 Epiglottitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/452

  Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken. […] Diagnosis is made on clinical grounds, and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected. […] Pertinent diagnostic criteria include the classic „tripod” position of the patient, drooling, high fever, and a toxic appearance. […] Key diagnostic factors include nonvaccination with Hib vaccine, sore throat, dysphagia, difficulty in controlling secretions, toxic appearance, acute distress, fever, tripod position, and difficulty breathing. […] 1st tests to order include laryngoscopy and erect lateral neck radiograph. […] Tests to consider include complete blood count and cultures of blood/supraglottis (epiglottis).

• #59 Epiglottitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000605.htm

  Epiglottitis can be a medical emergency. Seek medical help right away. Do not use anything to press the tongue down to try to look at the throat at home. Doing so may make the condition worse. […] The health care provider may examine the voice box (larynx) using a small mirror held against the back of the throat. Or a viewing tube called a laryngoscope may be used. This examination is best done in the operating room or a similar setting where sudden breathing problems can be more easily handled. […] Tests that may be done include: Blood culture or throat culture, Complete blood count (CBC), Neck x-ray.

• #60 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. […] Diagnosis requires direct visualization of the supraglottic structures; this procedure is not to be done until full respiratory support is available. […] Epiglottitis is suspected in patients with severe sore throat and no pharyngitis and in patients with sore throat and inspiratory stridor. […] The patient is hospitalized if epiglottitis is suspected. Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] Cultures from the supraglottic tissues and blood can then be taken to search for the causative organism. […] If the diagnosis is suspected, do flexible fiberoptic laryngoscopy in the operating room; reserve imaging tests for cases with very low suspicion.

• #61

  https://journals.lww.com/joad/fulltext/2020/09030/clinical_characteristics_and_treatment_of_acute.4.aspx

  To evaluate the clinical profiles, diagnosis, and treatment of patients with acute epiglottitis at a tertiary care teaching hospital of eastern India. […] The diagnosis of acute epiglottitis was based on the clinical presentations and fiberoptic laryngoscopic examinations of the larynx and hypopharynx. […] Clinical presentations alone are insufficient for the diagnosis of acute epiglottitis. Fiberoptic nasopharyngolaryngoscopic examination should be performed as soon as possible for confirmation of the disease. […] The diagnosis of AE was based on the clinical history and otorhinolaryngological examination, and then the diagnosis was confirmed by nasopharyngolaryngoscopic examination which showed swollen cherry red appearance epiglottis in all patients (100%). […] Diagnosis methods include direct laryngoscopic examinations and imaging. Direct manipulation of the larynx should be avoided as it can lead to rapid airway compromise. In AE cases, the direct fiberoptic laryngoscopic examination of the larynx shows inflamed edematous epiglottis. […] However, the gold standard investigation is direct expert laryngoscopy.

• #62 Acute epiglottitis: Trends, diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3498669/

  Acute epiglottitis is a life-threatening disorder with serious implications to the anesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. Early diagnosis with careful and rapid intervention of this serious condition is necessary in order to avoid life-threatening complications. […] The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. […] In acute epiglottitis, the radiological thumb sign is indicative of severe inflammation of the epiglottis with potential for irrevocable loss of the airway. […] Patients with signs of an advancing upper airway obstruction, consistent with an acute epiglottitis, should be treated as a medical and an airway emergency. […] Acute epiglottitis is a serious condition necessitating careful and rapid intervention in order to avoid life-threatening complications.

• #63 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. […] Diagnosis requires direct visualization of the supraglottic structures; this procedure is not to be done until full respiratory support is available. […] Epiglottitis is suspected in patients with severe sore throat and no pharyngitis and in patients with sore throat and inspiratory stridor. […] The patient is hospitalized if epiglottitis is suspected. Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] Cultures from the supraglottic tissues and blood can then be taken to search for the causative organism. […] If the diagnosis is suspected, do flexible fiberoptic laryngoscopy in the operating room; reserve imaging tests for cases with very low suspicion.

• #64 Epiglottitis with a Complication of Epiglottic Abscess: A Case Report and Review of the Literature – Eurasian Journal of Emergency Medicine

  https://eajem.com/articles/epiglottitis-with-a-complication-of-epiglottic-abscess-a-case-report-and-review-of-the-literature/doi/eajem.galenos.2023.59455

  Epiglottitis is a life-threatening condition that can result in a 10% mortality rate in adults. […] Prompt diagnosis and management are crucial for preventing airway compromise and respiratory failure. […] The diagnosis of epiglottitis relies on the physician’s suspicion along with the patient’s acute clinical presentation. […] If there are signs of airway compromise, a lateral neck X-ray may confirm the condition through the thumb sign but is not always necessary. […] When an EA is suspected, a CT scan is an appropriate diagnostic test for stable patients. […] The primary management step for epiglottitis is airway protection. […] Delayed or inadequate treatment may lead to life-threatening airway obstruction. […] Patients who present with clinical features of airway obstruction or have been diagnosed with EA should be transported to the operating room for further airway management and drainage, often following tracheal intubation.

• #65 Epiglottitis with a Complication of Epiglottic Abscess: A Case Report and Review of the Literature – Eurasian Journal of Emergency Medicine

  https://eajem.com/articles/epiglottitis-with-a-complication-of-epiglottic-abscess-a-case-report-and-review-of-the-literature/doi/eajem.galenos.2023.59455

  The use of laryngeal biopsy forceps under local anesthesia instead of general anesthesia for treating EA was found to be more practical, simpler, and inexpensive. […] Prompt diagnosis and management, including securing the airway, administering IV antibiotics, and performing surgical drainage, are crucial in preventing life-threatening complications and ensuring a favorable outcome for the patient. […] Clinicians should be vigilant for symptoms such as severe sore throat, dysphagia, odynophagia, fever, and rapid progression of symptoms in the context of known or suspected epiglottitis.

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