Epiglottitis in the adult patient

R B Mathoera, P C Wever, F R C van Dorsten, S G T Balter, C P C de Jager
Netherlands Journal of Medicine 2008, 66 (9): 373-7
Epiglottitis is an acute disease, which was predominantly caused by Haemophilus influenzae type b in the pre-vaccination era. In the vaccination era, with waning vigilance, adults remain at risk for acute epiglottitis according to recent Dutch incidence rates. There is more diversity in the cause of epiglottitis in adults. We describe three patients who presented to the emergency ward of a regional teaching hospital with severe epiglottitis. All three patients had stridor at presentation indicating a compromised airway. Emergency intubation was attempted, but two patients required a tracheotomy and one patient died. Patients received fibreoptic nasal intubation, systemic dexamethasone and antibiotics. Stridor is an important acute sign of upper airway obstruction, which requires vigilance for epiglottitis, regardless of the patient's age. Fibreoptic nasal intubation should preferentially be attempted with the possibility of immediate surgical airway on hand. Timely diagnosis and treatment usually results in a complete recovery. In adults, severe acute epiglottitis and stridor can justify early intubation.

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