Acute epiglottitis in adults

Abstract Epiglottitis occurs more frequently in adults than is generally realized. More than 100 adults with epiglottitis have been reported prior to this paper. Sixty‐two have been reported in the last 15 years. The mortality rate of these 62 patients was 32 percent. Tracheostomy was required in 45 percent of those who recovered. Seventeen adults with epiglottitis have been managed at the Los Angeles County/University of Southern California Medical Center in the past 10 years; 13 of these were seen in the last four years. Most were males between 20 and 45 years of age. Four required tracheostomy. There were no deaths. An additional adult, treated at a neighboring hospital, who recovered from Hemophilus influenzae epiglottitis and meningitis is reported. He required tracheostomy for acute airway obstruction. The following impressions can be derived from an anlysis of the literature and the patients discussed in this paper: 1. epiglottitis in adults has been reported more often in recent years. This may be due to increased awareness of this condition; or it may be due to actual increased incidence. 2. Epiglottis is more severe when due to Hemophilus influenzae, Type B than when due to other pathogens; and infections due to H. influenzae are being noted more frequently in adults. 3. The primary treatment of adult epiglottitis is: mist tent, intravenous antibiotics, and tracheostomy when indicated. Steroids may benefit some patients by slowing progression of epiglottic edema. 4. The symptoms of epiglottitis are sore throat, dysphagia, respiratory distress, and muffled voice. The characteristic early symptoms are sore throat and dysphagia. Any patient with acute painful dysphagia should have indirect laryngoscopy to rule out epiglottitis.