1
|
Huang SY, Hsu CM, Yang YH, Tsai YH, Tsai MS, Chang GH, Liu CY, Lee YC, Huang EI, Tsai YT. Elevated risk of acute epiglottitis in patients with chronic obstructive pulmonary disease: A nationwide cohort study. PLoS One 2022; 17:e0273437. [PMID: 35984835 PMCID: PMC9390908 DOI: 10.1371/journal.pone.0273437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
In individuals with epiglottitis, chronic obstructive pulmonary disease (COPD) is a common comorbidity; however, the impact of COPD under such circumstances is not well documented. Therefore, we performed this population-based study to determine whether, in adults, COPD is a risk factor for epiglottitis.
Methods
In this retrospective matched-cohort study, data obtained from the Taiwan National Health Insurance Research Database were analyzed. We identified all patients newly diagnosed as having COPD in 2000–2011 and performed frequency matching and propensity-score matching for every patient with COPD individually to another patient without a COPD diagnosis. We used epiglottitis occurrence as the study endpoint, and we investigated the hazard ratio of epiglottitis by using the Cox proportional hazards model after adjustment for potential confounders.
Results
In the frequency matching, the cumulative epiglottitis incidence was significantly higher (p = 0.005) in the COPD cohort. According to the adjusted Cox proportional hazard model, COPD exhibited a significant association with elevated epiglottitis incidence (adjusted hazard ratio: 1.76; 95% confidence interval: 1.15–2.70, p = 0.009). Similar trend was observed in the propensity-score matching analysis (adjusted hazard ratio: 1.50; 95% confidence interval: 0.99–2.29, p = 0.057). Our subgroup analysis revealed COPD to be an epiglottitis risk factor in male patients and those aged 40–64 years.
Conclusions
This is the first nationwide matched-cohort research to examine the association of COPD with epiglottitis. Our results revealed that COPD may be a potential risk factor for epiglottitis; thus, clinicians should be mindful of the potential increased risk of epiglottitis following COPD.
Collapse
Affiliation(s)
- Shu-Yi Huang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ethan I. Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
| |
Collapse
|
2
|
High risk and low prevalence diseases: Adult epiglottitis. Am J Emerg Med 2022; 57:14-20. [PMID: 35489220 DOI: 10.1016/j.ajem.2022.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022] Open
|
3
|
Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:65-70. [PMID: 35181262 DOI: 10.1016/j.redare.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/26/2021] [Indexed: 06/14/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
Collapse
Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| |
Collapse
|
4
|
Felton P, Lutfy-Clayton L, Smith LG, Visintainer P, Rathlev NK. A Retrospective Cohort Study of Acute Epiglottitis in Adults. West J Emerg Med 2021; 22:1326-1334. [PMID: 34787558 PMCID: PMC8597686 DOI: 10.5811/westjem.2021.8.52657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/24/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Adult epiglottitis is a disease process distinct from pediatric epiglottitis in microbiology, presentation, and clinical course. While traditionally considered more indolent and benign than in children, adult epiglottitis remains a cause of acute airway compromise with a mortality rate from 1-20%. Our objective was to characterize the disease course and evaluate the rate and type of airway management in this population at a tertiary, academic referral center. METHODS We conducted a retrospective chart review of all adult patients (age ≥ 18) who were definitively diagnosed with infectious "epiglottitis," "supraglottitis," or "epiglottic abscess" by direct or indirect laryngoscopy during a nine-year period. Double data abstraction and a standardized data collection form were used to assess patient demographic characteristics, presenting features, and clinical course. The primary outcome was airway intervention by intubation, cricothyroidotomy, or tracheostomy, and the secondary outcome was mortality related to the disease. RESULTS Seventy patients met inclusion criteria. The mean age was 50.2 years (standard deviation ± 16.7), 60% of the patients were male, and 14.3% were diabetic. Fifty percent had symptoms that were present for ≥ 48 hours; 38.6% had voice changes, 13.1% had stridor, 12.9% had fever, 45.7% had odynophagia, and 47.1% had dysphagia noted in the ED. Twelve patients (17.1%) received an acute airway intervention including three who underwent emergent cricothyroidotomy, and one who had a tracheostomy. Two patients died and one suffered anoxic brain injury related to complications following difficult airway management. CONCLUSION In this case series the majority of patients (82.9%) did not require airway intervention, but a third of those requiring intervention (5.7% of total) had a surgical airway performed with two deaths and one anoxic brain injury. Clinicians must remain vigilant to identify signs of impending airway compromise in acute adult epiglottitis and be familiar with difficult and failed airway algorithms to prevent morbidity and mortality in these patients.
Collapse
Affiliation(s)
- Patrick Felton
- University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Lucienne Lutfy-Clayton
- University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Liza Gonen Smith
- University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Paul Visintainer
- University of Massachusetts Medical School-Baystate, Department of Epidemiology and Biostatistics, Springfield, Massachusetts
| | - Niels K Rathlev
- University of Massachusetts Medical School-Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| |
Collapse
|
5
|
Fernandes-Teles AR, Pina-Amado JM, Pereira JM, Paiva JA, Rocha-Silva S. Approaching the airway in prehospital emergency is a common and potentially life-saving practice. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00109-2. [PMID: 34544597 DOI: 10.1016/j.redar.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 06/13/2023]
Abstract
Management by the environment is complex, which means a much higher percentage of difficult airways than in a regulated environment such as the operating room. Failure or prolonged attempt to tracheal intubation is associated with unfavorable outcomes and serious complications. Acute epiglottitis is a life-threatening disorder, classified as a medical emergency within the diseases of the upper respiratory airway and characterized by its sudden and deadly evolution if rapid intubation is not achieved to allow oxygenation of the patient. We describe a 36-year-old male patient with stridor, dyspnea e hypoxemia due to total obstruction of airway, caused by an acute epiglottitis. We aim to highlight this unusual injury and its management from the prehospital until discharge illustrating the severity of the clinical presentation, current treatment and outcome.
Collapse
Affiliation(s)
- A R Fernandes-Teles
- Department of Anaesthesiology, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal.
| | - J M Pina-Amado
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| | - J M Pereira
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Paiva
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - S Rocha-Silva
- Department of Intensive Care, Centro Hospitalar e Universitário São João, EPE, Porto, Portugal
| |
Collapse
|
6
|
Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog 2020; 67:90-97. [PMID: 32633776 DOI: 10.2344/anpr-66-04-08] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/18/2019] [Indexed: 11/11/2022] Open
Abstract
Epiglottitis is most commonly caused by bacterial infection resulting in inflammation and edema of the epiglottis and neighboring supraglottic structures. Acute infection was once found predominantly in children ages 2 to 6 years old, but with the introduction of the Haemophilus influenzae B (HiB) vaccine the incidence of cases in adults is increasing. Typical clinical presentation of epiglottitis includes fever and sore throat. Evidence of impending airway obstruction may be demonstrated by muffled voice, drooling, tripod position, and stridor. Radiographs can be helpful in diagnosing epiglottitis; however, they should not supersede or postpone securing the airway. An airway specialist such as an otolaryngologist, anesthesiologist, or intensivist should ideally evaluate the patient immediately to give ample time for preparing to secure the airway if necessary. All patients with epiglottitis should be admitted to the intensive care unit for close monitoring.
Collapse
Affiliation(s)
- Regina A E Dowdy
- Resident, Division of Oral and Maxillofacial Surgery and Dental Anesthesiology, The Ohio State University, Columbus, Ohio
| | - Bryant W Cornelius
- Program Director of Dental Anesthesiology, Division of Oral and Maxillofacial Surgery and Dental Anesthesiology, The Ohio State University, Columbus, Ohio
| |
Collapse
|
7
|
Infected Lingual Thyroglossal Duct Cyst Mimicking Supraglottitis. J Craniofac Surg 2019; 30:e380-e382. [PMID: 30882577 DOI: 10.1097/scs.0000000000005427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A thyroglossal duct cyst (TGDC) is a common embryological remnant that typically presents as an anterior neck mass; however, this malformation can occur in any adjacent area, including the tongue base (lingual type), along the migration path of the thyroid during embryonic development. Lingual TGDC is often quiescent until infection occurs. Supraglottitis or inflammation of the supraglottis, is a potentially life-threatening disease. Because of the anatomical proximity of lingual TGDC to the supraglottis, lingual TGDC infection might be related to a presentation of supraglottitis. A 49-year-old male initially presented with clinical symptoms of acute supraglottitis. After intensive medical treatment resulting in no improvement, a computed tomography scan was performed. The result raised the suspicion of an infected lingual TGDC. Transoral marsupialization using a rigid laryngoscope was performed to drain the abscess inside the cyst. A diagnosis of lingual TGDC was made based on the characteristic histological pattern of the lesion. After treatment, a follow-up computed tomography scan showed no evidence of recurrence. To the authors' knowledge, only a few reports have pointed out similarities in the clinical and radiological findings between acute supraglottitis and an infected lingual TGDC. Clinicians should consider lingual TGDC during the differential diagnosis of supraglottitis, especially in patients with poor response to medical treatment.
Collapse
|
8
|
Hanna J, Brauer PR, Berson E, Mehra S. Adult epiglottitis: Trends and predictors of mortality in over 30 thousand cases from 2007 to 2014. Laryngoscope 2018; 129:1107-1112. [DOI: 10.1002/lary.27741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Jonathan Hanna
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutU.S.A
| | - Philip R. Brauer
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutU.S.A
| | - Elisa Berson
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutU.S.A
| | - Saral Mehra
- Department of Surgery, Section of OtolaryngologyYale University School of Medicine, Yale‐New Haven Hospital, Yale Cancer CenterNew HavenConnecticutU.S.A
| |
Collapse
|
9
|
Goel N, Bhardwaj N, Gupta A, Gowtham K. Giant vallecular cyst excision in infant: Should we proceed without a definite airway? Saudi J Anaesth 2018; 12:647-649. [PMID: 30429754 PMCID: PMC6180690 DOI: 10.4103/sja.sja_149_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nitika Goel
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gowtham
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
10
|
Abstract
Abstract
Due to the potentially unforgiving nature of epiglottitis and supraglottitis, the clinician should have a firm understanding of the presentation, work up, and management of a patient presenting with worrisome symptoms.
Collapse
|
11
|
Lee SH, Yun SJ, Kim DH, Jo HH, Ryu S. Do we need a change in ED diagnostic strategy for adult acute epiglottitis? Am J Emerg Med 2017; 35:1519-1524. [DOI: 10.1016/j.ajem.2017.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022] Open
|
12
|
Fujiwara T, Miyata T, Tokumasu H, Gemba H, Fukuoka T. Diagnostic accuracy of radiographs for detecting supraglottitis: a systematic review and meta-analysis. Acute Med Surg 2016; 4:190-197. [PMID: 29123860 PMCID: PMC5667265 DOI: 10.1002/ams2.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/22/2016] [Indexed: 11/06/2022] Open
Abstract
Aim To assess the diagnostic performance of lateral radiograph of the neck for supraglottitis in adults and children. Methods Electronic database searches (including PubMed, EMBASE, CINAHL, Web of Science, and WHO International Clinical Trials Registry Platform) were carried out through July 2014. Citations of included studies and recent narrative reviews were searched. Studies that compared lateral radiograph of the neck with a reference standard of direct/indirect laryngoscopy were included. Two reviewers independently assessed the methodological quality of included studies by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Results Of 2,088 potentially relevant citations, two single-gate (cohort) studies and six two-gate (case-control) studies were identified. These included studies of design are at the moderate or high risk of bias in QUADAS-2. The pooled sensitivity from bivariate random-effects regression was 92.9% (95% confidence interval [CI], 88.5-95.9%) and the pooled specificity was 89.2% (95% CI, 85.9-91.9%), but the diagnostic value would be overestimated because of selection bias in the six two-gate studies. The sensitivity and specificity of the single-gate studies were 100.0% (95% CI, 92.2-100.0%) and 30.6% (95% CI, 15.5-35.6%) in children and 81.0% (95% CI, 78.2-93.2%) and 85.7% specificity (95% CI, 78.2-93.2%) in adults. Conclusion This study determines that there are insufficient studies of lateral neck radiograph for detecting supraglottitis. Lateral radiograph of the neck seems to have moderate accuracy for detecting supraglottitis. Further approximately unbiased studies are needed to obtain more valid and reliable estimates of test accuracy.
Collapse
Affiliation(s)
- Takashi Fujiwara
- Department of Otolaryngology Head and Neck surgery Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Toyohisa Miyata
- Department of Pediatrics Ehime University Hospital Shitsukawa To-on city Ehime Japan
| | | | - Hiroko Gemba
- Department of LibraryKurashiki Central Hospital Kurashiki Okayama Japan
| | - Toshio Fukuoka
- Center of Emergency and Critical Care Kurashiki Central Hospital Kurashiki Okayama Japan
| |
Collapse
|
13
|
Pregame Sore Throat, Postgame Intensive Care Unit. Clin J Sport Med 2016; 26:e71-3. [PMID: 26247550 DOI: 10.1097/jsm.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A collegiate football athlete presented, on game day, with an acute onset of sore throat. He was afebrile, speaking in full sentences, without signs of respiratory distress. His examination was negative for lymphadenopathy or tonsillar enlargement or exudate. Twelve hours after initial presentation, he developed acute epiglottitis. He underwent urgent fiberoptic intubation and was empirically treated with broad-spectrum antibiotics and corticosteroids. Currently, there are no published reports of acute epiglottitis in athletes. Consequently, there is no evidence to guide return to play decisions. Return to play, following acute epiglottitis, should include resolution of symptoms and a graded return to play, taking into consideration the level of deconditioning the athlete experienced from hospitalization.
Collapse
|
14
|
|
15
|
Lee YC, Lee JW, Park GC, Eun YG. Efficacy of Spinal Needle Aspiration in Patients with Epiglottic Abscess. Otolaryngol Head Neck Surg 2015; 153:48-53. [DOI: 10.1177/0194599815583475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/25/2014] [Indexed: 11/16/2022]
Abstract
Objective/Hypothesis To evaluate the efficacy of spinal needle aspiration for symptom improvement in awake patients with epiglottic abscess (EA). Study Design Prospective randomized controlled study. Setting Tertiary center. Subjects and Methods Twenty-two patients who were diagnosed with EA were randomly allocated to group A (needle aspiration and antibiotics) or group B (antibiotics only). Patients’ characteristics, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification, and initial laboratory findings were analyzed. Needle aspiration was done under local anesthesia in awake patients using an 18-gauge spinal needle and indirect laryngoscope. Changes in the following symptoms during hospital stay were assessed: sore throat, hoarseness, dyspnea, odynophagia, and dysphagia. Results Eleven patients were treated with needle aspiration and antibiotics, and 11 patients were treated with antibiotics only. There was no statistically significant difference between the 2 groups regarding age, sex, white blood cell count, C-reactive protein, presenting clinical symptoms, abscess size, and scope classification at time of diagnosis. Patients in both groups had significant improvement in all clinical symptoms. While there were no between-group differences in improvement for any of the symptoms, the length of hospitalization was significantly lower in group A (4.0 ± 1.9 days) than in group B (5.7 ± 1.2 days) ( P = .037). Conclusion We did not find any significant additional benefit of needle aspiration for the treatment of EA, with the exception that needle aspiration reduced the length of hospitalization. Further proof with a large-scale study is needed.
Collapse
Affiliation(s)
- Young Chan Lee
- Department of Otolaryngology–Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung-Woo Lee
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Gi Cheol Park
- Department of Otolaryngology, Samsung Changwon Hospital, Sungkyun-kwan University School of Medicine, Changwon, Korea
| | - Young Gyu Eun
- Department of Otolaryngology–Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Orhan İ, Aydın S, Karlıdağ T. Infectious and Noninfectious Causes of Epiglottitis in Adults, Review of 24 Patients. Turk Arch Otorhinolaryngol 2015; 53:10-14. [PMID: 29391970 DOI: 10.5152/tao.2015.718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/22/2014] [Indexed: 11/22/2022] Open
Abstract
Objective The present study reports the etiological differences, clinical features, management, and patient outcomes between infectious and noninfectious causes of epiglottitis in adult patients. Methods The medical records of 24 patients with infectious and noninfectious epiglottitis were investigated. Diagnosis was made by anamnesis and endoscopic examination. On admission, respiratory distress of patients was classified according to Freidman's classification. Results Fifteen patients were male, and nine patients were female. Their ages ranged between 24 and 69 years of age (mean, 43.4±11.6). In total, 16 patients were diagnosed with infectious epiglottitis, and eight patients were diagnosed with noninfectious epiglottitis. Of patients with noninfectious epiglottitis, two had angioedema, two had experienced organophosphate ingestion, one had experienced hot water aspiration, one had experienced hot milk aspiration, one had experienced foreign body aspiration (fishbone), and one had epiglottitis due to Behçet's disease. Sore throat was the most common symptoms of infectious and noninfectious epiglottitis in our patients. Odynophagia was the second most common symptom of infectious epiglottitis, and muffled voice was the second most common symptom in noninfectious patients. Conclusion Epiglottit is an emergency situation; when a patient is diagnosed with epiglottitis, close follow-up should be performed, and airway support should properly be maintained according to the degree of respiratory distress. Tracheostomy should be performed without hesitation, as needed.
Collapse
Affiliation(s)
- İsrafil Orhan
- Department of Otorhinolaryngology, Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Salih Aydın
- Clinic of Otorhinolaryngology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Turgut Karlıdağ
- Department of Otorhinolaryngology, Fırat University Faculty of Medicine, Elazığ, Turkey
| |
Collapse
|
17
|
O'Rourke C, Attique S, Rehman AU, Saunders J, Fenton JE. Hyoid bone tenderness as a clinical indicator of laryngeal pathology. J Voice 2014; 28:835-7. [PMID: 24954042 DOI: 10.1016/j.jvoice.2014.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/25/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hyoid bone tenderness is an underemphasized clinical abnormality and is described as discomfort or pain on gentle palpation of the greater cornu. The primary outcome of this study is to assess if there is any association between hyoid tenderness and laryngeal pathology. STUDY DESIGN This is a retrospective case-control study. METHODS Ninety-four subjects were identified. These were divided into two groups, those with hyoid tenderness and those without hyoid tenderness. Presenting complaints and findings on nasal laryngoscopy were compared to identify any association between hyoid tenderness and laryngeal pathology. RESULTS There were a total of 76 (80.9%) female and 18 (19.1%) male patients in the study. Analysis of presenting complaints showed that dysphonia (P < 0.001, odds ratio = 4.82) and neck pain (P = 0.015, odds ratio = 10.9) were significantly associated with hyoid tenderness, more with these symptoms had hyoid tenderness than expected by chance. Findings on nasal laryngoscopy showed a significant association between hyoid tenderness and vocal fold nodules (P < 0.001). Nasopharyngitis (P = 0.065) and tense anterior neck muscles (P = 0.056) were almost significantly associated with hyoid tenderness. CONCLUSION Hyoid tenderness has previously been reported as an early sign in acute epiglottitis. These results indicate that hyoid bone tenderness may be a useful clinical indicator of various other laryngeal pathologies or dysfunctions.
Collapse
Affiliation(s)
- Colin O'Rourke
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Limerick, Ireland.
| | - Sarwar Attique
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Limerick, Ireland
| | - Aziz Ur Rehman
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Limerick, Ireland
| | - Jean Saunders
- Department of Statistics, University of Limerick, Limerick, Ireland
| | - John E Fenton
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
18
|
Tan TH, Hsu CC, Liao YY, Chen KT. Computed tomography scan as a diagnostic tool for supraglottitis in adults. Am J Emerg Med 2014; 32:1279-80. [PMID: 25124027 DOI: 10.1016/j.ajem.2014.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/13/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tian-Hoe Tan
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan
| | - Yu-Ying Liao
- Emergency Department, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Kuo-Tai Chen
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
19
|
Wilkie MD, Leong SC, Panarese A, Banerjee A. Hyperplastic epiglottis caused by chronic inflammation. EAR, NOSE & THROAT JOURNAL 2013; 92:E22-3. [PMID: 23354898 DOI: 10.1177/014556131309200123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mark D Wilkie
- ENT Department, Royal Liverpool and Broadgreen University Hospitals, Liverpool, England
| | | | | | | |
Collapse
|
20
|
Derber CJ, Troy SB. Head and neck emergencies: bacterial meningitis, encephalitis, brain abscess, upper airway obstruction, and jugular septic thrombophlebitis. Med Clin North Am 2012; 96:1107-26. [PMID: 23102480 DOI: 10.1016/j.mcna.2012.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Head and neck infectious disease emergencies can be rapidly fatal without prompt recognition and treatment. Empiric intravenous (IV) antibiotics should be initiated immediately in any patient with suspected bacterial meningitis, and IV acyclovir in any patient with suspected encephalitis. Surgical intervention is often necessary for brain abscesses, epiglottitis, and Ludwig's angina. A high index of suspicion is often needed to diagnose epiglottitis, Ludwig's angina, and Lemierre's syndrome. Brain infections can have high morbidity among survivors. In this article, the causes, diagnostic tests, treatment, and prognosis are reviewed for some of the more common head and neck infectious disease emergencies.
Collapse
Affiliation(s)
- Catherine J Derber
- Department of Internal Medicine, Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk, VA, USA.
| | | |
Collapse
|
21
|
Acute epiglottitis in the era of post-Haemophilus influenzae type B (HIB) vaccine. J Anesth 2012; 27:316-7. [DOI: 10.1007/s00540-012-1500-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
|
22
|
Jahagirdar SM, Karthikeyan P, Ravishankar M. Acute airway obstruction, an unusual presentation of vallecular cyst. Indian J Anaesth 2012; 55:524-7. [PMID: 22174474 PMCID: PMC3237157 DOI: 10.4103/0019-5049.89896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 18-year-old female presented to us with acute respiratory obstruction, unconsciousness, severe respiratory acidosis, and impending cardiac arrest. The emergency measures to secure the airway included intubation with a 3.5-mm endotracheal tube and railroading of a 6.5-mm endotracheal tube over a suction catheter. Video laryngoscopy done after successful resuscitation showed an inflamed swollen epiglottis with a swelling in the left vallecular region, which proved to be a vallecular cyst. Marsupialisation surgery was performed on the 8th post admission day and the patient discharged on 10th day without any neurological deficit.
Collapse
Affiliation(s)
- Sameer M Jahagirdar
- Department of Anaesthesiology & Critical Care Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | | | | |
Collapse
|
23
|
Subramaniam R. Acute upper airway obstruction in children and adults. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2011. [DOI: 10.1016/j.tacc.2011.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|