Acute epiglottitis

1. Acute epiglottitisAcute epiglottitis
R.NandiniiR.Nandinii
Group K1Group K1

2. Anatomy:
•Leaf like, yellow, elastic cartilage forming anterior
wall of laryngeal inlet.
•Attached to body of hyoid bone by hyoepiglottic
ligament which divides it into suprahyoid &
infrahyoid epiglottis.
•Stalk like process of epiglottis to the thyroid
angle.
•Anterior surface of epiglottis is separated from
thyrohyoid membrane & upper part of thyroid
cartilage by a potential space filled with fat- pre-
epiglottic space .
•Space can be invaded in carcinoma of supraglottic
larynx or base of tongue.

3. Supraglottic structures, eg epiglottis, aryepiglottic
folds and arytenoids.

4. Acute Epiglottitis (Syn. Supraglottic laryngitis)
Definition:
Acute inflammatory condition confined to supraglottic structures:-
-epiglottis
-aryepiglottic folds
-arytenoids
There is marked edema of these structures which may obstruct the
airway.

5. Aetiology:
•Classically described as a
Haemophilus Influenzae
type b bacterial infection of
the epiglottis in children. In
adults only 20% of
epiglottitis is caused by
haemophilus influenzae.
Figure 3.0: Organisms that can cause acute epiglottitis in adults.

6. Symptoms:
•Odynophagia
•Inability to swallow secretions
•Sore throat
•Muffled voice- “hot potato voice”
•hoarseness
•cough
•dyspnoea

7. Signs:
•Fever (>37.2 °C)
•Tachycardia (100 bpm)
•Pharyngitis
•Swelling of the epiglottis
•Cervical lymph nodes
•Swelling of supraglottic tissue
•Inspiratory stridor
•Drooling/inability to handle secretion

8. Examination:
•Depressing the tongue with a tongue depressor may show red & swollen
epiglottis.
• Indirect laryngoscopy may show oedema & congestion of supraglottic
structures. This examination is avoided for fear of precipitating complete
obstruction. (Better done in OT where facilities for intubation are
available.
•Lateral soft tissue X-ray of neck may show swollen epiglottis (thumb sign)

9. Examination:
•CT & MRI helpful to evaluate the complications of this disorder, which
include spread of the infection and abscess formation. Thickening of the
epiglottis, obliteration of the pre-epiglottic fat and thickening of the
subcutaneous tissue and muscles are common radiological findings in
epiglottic abscess

11. A lateral soft-tissue radiograph
of the neck showed a “thumb sign” (arrow). This
radiographic sign is a manifestation of an
enlarged and edematous epiglottis, and it
suggests a diagnosis of acute infectious
epiglottitis.

12. In this view of the larynx obtained with nasopharyngoscope, the larynx is shown with breathing (left image, cords abducted) and the with
phonation (cords adducted):
• the wide arrowheads mark the left aryepiglottic fold
• the asterisk is at the interarytenoid notch
• the round dots mark the right posterior cartilages (cuneiform and corniculate cartilages)

The normal orientation for a nasopharyngoscope is to have the epiglottis (anterior) at the bottom of the image, and the posterior cartilages at the
top. This image has been flipped to match the perspective with direct laryngoscopy (epiglottis at top). The small black notch on the bottom
perimeter of the image is part of the scope eyepiece; it lets the operator determine the orientation of the scope, and an endoscopic camera on the
eyepiece.
Source: Airway Cam Technologies,2011)

13. Differential Diagnosis:
•DDx of adult epiglottitis includes:
•Infectious processes:
Mononucleosis, diphtheria, pertussis, croup, tonsillitis, Ludwig’s angina with
retropharyngeal, Peripharyngeal and peritonsillar abscesses, tracheobronchitis,
subglottic laryngitis.

•Non-infectious diseases
Allergic reactions, angioneurotic oedema, foreign body aspiration, reflex
laryngospasm, laryngeal trauma, tumours, hydrocarbon aspiration, systemic lupus
erythematosis and inhalation of toxic fumes or superheated steam

14. Complications
•In some cases, an infection can spread from the epiglottis to nearby parts
of the body, including the:
•inner ear (otitis media)
•brain (meningitis)
•heart lining (pericarditis)
•lungs (pneumonia)

15. Treatment
1.Hospitalisation danger of respiratory obstruction
2.Antibiotics  Ampicillin
 third gen.cephalosporin


- effective against
H.influenzae
- given by parenteral route
(i.m/i.v)
3. Steroids hydrocortisone/dexamethasone (i.m/i.v)
4. Adequate hydrationparenteral fluids
5. Humidification and oxygen
6.Intubation or tracheostomy respiratory obstruction

16. Algorithme for management of epiglottitis

17. Source: Acute Adult Supraglottitis: Current Management and Treatment Mohannad Al-Qudah, MD, FAAOHNS, Shetty, S. MD, M. Alomari, MD, Maen Alqdah,
FRCPC, FCCP South Med J. 2010;103(8):800-804.-Medscape-

18. Prognosis:
•The prognosis in adults with acute epiglottitis is good with appropriate and timely
treatment.
•Most patients can be extubated within several days.
•However, unrecognized epiglottitis may rapidly lead to airway compromise and
resultant death.
•In spite of acute epiglottitis generally having a good prognosis, the risk of death for
persons is high due to sudden airway obstruction and difficulty intubating patients
with extensive swelling of supraglottic structures.
•Reported cases do include sudden fatal cardiorespiratory arrest occurring in patients
without previous evidence of respiratory obstruction while in an intensive care unit
(ICU) setting, emphasizing the importance of providing close monitoring and
adequate airway protection in these patients. The adult mortality rate is around 7%.
Source: Emedicine, 2013