Adult epiglottitis: The Toronto Hospital experience

Objective: This study was conducted to gain insight into the diagnosis, treatment, and outcome measures in adult patients presenting with acute epiglottitis. Method: A retrospective clinical study was conducted on fifty-seven consecutive adult patients presenting with acute epiglottis over a 13-year period to The Toronto Hospital, University of Toronto. Demographic description of patient population, presenting symptoms and signs, investigations performed, treatment provided, and incidence of complications were described. Results: Soft-tissue lateral neck x-rays were abnormal in 88.1% of patients tested but had a 12% false-negative rate. Indirect, direct, or flexible laryngoscopy were the most accurate investigations to establish diagnosis and were not associated with any complications. Four of 45 patients (8.9%) had positive blood cultures for Haemophilus influenzae, with the remainder demonstrating no growth, while 22% of patients (8/36) grew possible pathogenic organisms on throat culture. A rapid clinical course (< 12 hr), evidence of tachycardia, or positive pharyngeal or blood cultures were factors that selected for a group of patients requiring formal airway intervention. Conclusions: Adult epiglottitis is different from its paediatric counterpart in that organism identification is less common, the clinical course is more gradual, there is less seasonal variation, airway compromise is more uncommon, and conservative airway management can be contemplated in the selected patient. Adult epiglottitis can be managed safely with a selective approach to airway management with airway intervention for any patient with signs of critical airway compromise.