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Jeng PH, Huang TR, Shih CP. Giant Epiglottic Cyst: A Comprehensive Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2024:1455613241259291. [PMID: 38804658 DOI: 10.1177/01455613241259291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Po-Hsuan Jeng
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tien-Ru Huang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Cheng-Ping Shih
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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2
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Lu F, Wang Y, Miao F, Han C, Meng X. Rising Incidence of Acute Epiglottitis in Eastern China: An Eight-Year Retrospective Study and Its Association with the 24 Solar Terms. Int J Gen Med 2024; 17:1665-1676. [PMID: 38706753 PMCID: PMC11068044 DOI: 10.2147/ijgm.s458019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose This study aimed to investigate the clinical characteristics of acute epiglottitis (AE) patients in East China and examine the correlation between the incidence of AE and the 24 solar terms (24 STs). Methods A retrospective, observational study was conducted on patients diagnosed with AE between January 2014 and December 2021 at a single-center medical institution in East China. The clinical characteristics of patients with AE and their correlation with the 24 STs were investigated. Results A total of 287 patients with AE were included in this study, among which there were 179 males (62.37%) and 108 females (37.63%), with a mean age of 47.79 ± 13.83 years (range 16-87 years). Of these patients, 100 (34.84%) had at least one comorbidity and the most common comorbidities were hypertension, smoking and type 2 diabetes. The duration of hospitalization was 3 days (IQR, 1-16 days). All patients, except for one who required tracheal intubation, were cured with intravenous antibiotic administration and the combined use of corticosteroids. The incidence of AE showed significant fluctuations between the 24 STs and the highest number of cases occurred during the Summer solstice (24 cases, 8.36%). Conclusion The incidence of AE was seen to increase annually in this study. The main features of AE are sore throat, dysphagia, odynophagia and fever, which may be accompanied by inflammation in surrounding areas. A clear correlation exists between the incidence of AE and the fluctuations within the 24 STs, notably with the peak incidence observed during the Summer solstice, which approximately corresponds to June 21 to July 7 in the Gregorian calendar.
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Affiliation(s)
- Feng Lu
- Department of Emergency Medicine, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Yangyang Wang
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Fangyu Miao
- Information Centre, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Chengzhou Han
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
| | - Xiangming Meng
- Department of Otolaryngology, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi Huishan District People’s Hospital, Wuxi, 214187, People’s Republic of China
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Booth AW, Pungsornruk K, Llewellyn S, Sturgess D, Vidhani K. Airway management of adult epiglottitis: a systematic review and meta-analysis. BJA OPEN 2024; 9:100250. [PMID: 38230383 PMCID: PMC10789606 DOI: 10.1016/j.bjao.2023.100250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
Background Adult epiglottitis is a life-threatening airway emergency where airway protection is the immediate priority. Despite its importance, the optimal approach to airway management remains unclear. We performed a systematic review of the airway management for adult epiglottitis, including meta-analysis of trends over time. Methods We systematically searched PubMed, Ovid MEDLINE®, and Embase® for adult epiglottitis studies that described the airway management between 1980 and 2020. The primary outcome was the prevalence of airway intervention. Secondary outcomes were prevalence of tracheal intubation, tracheostomy, and failed intubation. A random-effects model meta-analysis was performed with subgroups defined by decade of study publication. Cases that described the specific method of airway intervention and severity of epiglottitis were included in a separate technique summary. Results Fifty-six studies with 10 630 patients were included in the meta-analysis. The overall rate of airway intervention was 15.6% (95% confidence interval [CI] 12.9-18.8%) but the rate decreased from 20% to 10% between 1980 and 2020. The overall rate of tracheal intubation was 10.2% (95% CI 7.1-13.6%) and that of failed intubation was 4.2% (95% CI 1.4-8.0%). The airway technique summary included 128 cases, of which 75 (58.6%) were performed awake and 53 (41.4%) involved general anaesthesia. We identified 32 cases of primary technique failure. Conclusion The rate of airway intervention for adult epiglottitis has decreased over four decades to a current level of 10%. Tracheal intubation is a high-risk scenario with a 1 in 25 failure rate. Specific technique selection is most likely influenced by contextual factors including the severity of epiglottitis.
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Affiliation(s)
- Anton W.G. Booth
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Karla Pungsornruk
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - David Sturgess
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- The University of Queensland (UQ) and Surgical Treatment and Rehabilitation Service (STARS), Brisbane, Australia
| | - Kim Vidhani
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Ting LKN, Idris A, Mat Baki M. Rare cause of voice muffling: pyogenic vallecular cyst. BMJ Case Rep 2022; 15:e250615. [PMID: 36109094 PMCID: PMC9478783 DOI: 10.1136/bcr-2022-250615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A vallecular cyst is a benign laryngeal cyst that rarely causes symptoms in adults. We report a rare case of an infected vallecular cyst in a man who is in his 60s with diabetes mellitus. The patient presented to us with acute onset of voice muffling and respiratory distress. He showed signs of sepsis and upper airway obstruction. He had spikes of high-grade fever with an elevated total white cell count (predominantly neutrophil count) and C reactive protein level. Plain cervical X-ray revealed a large, smooth, lobulated mass in the vallecular area. Direct laryngoscopic findings supported the diagnosis of an infected vallecular cyst with suppuration, which originated from the vallecula fossa. The cyst was drained and excised completely, and the pus culture revealed the presence of Klebsiella pneumoniae The patient responded well to the administration of intravenous cefuroxime for 2 weeks according to the sensitivity and culture test. He was discharged after the completion of the course of antibiotics, having recovered fully. This case illustrates the versatility of a plain cervical X-ray in giving clues about this rare, unexpected pathology.
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Affiliation(s)
- Lorna Kang Ni Ting
- Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - Anuar Idris
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - Marina Mat Baki
- Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Sideris G, Papadimitriou N, Korres GF, Karaganis A, Maragkoudakis P, Nikolopoulos T, Delides A. Clinical and Microbiological Factors Associated With Abscess Formation in Adult Acute Epiglottitis. Ann Otol Rhinol Laryngol 2021; 131:1194-1201. [PMID: 34841913 DOI: 10.1177/00034894211051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate clinical and microbiological findings that are correlated with abscess formation in adult acute epiglottitis (AE). METHODS We reviewed 140 cases of adult AE. Demographic, clinical, imaging, and microbiological findings are analyzed for all patients with AE in comparison to those with epiglottic abscess (EA). RESULTS A total of 113 patients presented with AE and 27 presented or progressed to EA (19.3%). Age, sex, seasonality, smoking, body mass index (BMI), and comorbidities were statistically insignificant between the 2 groups. Muffled voice (P < .013), respiratory distress (P < .001), and pre-existence of epiglottic cyst (P < .001) are symptoms and signs connected with abscess formation. A total of 120 patients were treated conservatively. Surgical treatment was performed on 20 patients with EA. About 72 out of 80 cultures revealed monomicrobial infection. Mixed flora was isolated in 8 patients with EA. Streptococcus was isolated in 51 out of 80 positive cultures (64%). Haemophilus Influenza (Hib) was not isolated in any sample. EA and mixed flora relates to a higher rate of airway intervention (P < .001). CONCLUSION A high level of suspicion for abscess formation is required if clinical examination reveals dyspnea, muffled voice, or an epiglottic cyst in adult with AE. The existence of EA doubles the duration of hospitalization. EA is typically found on the lingual surface of the epiglottis. Supraglottic or deep neck space expansion should be treated surgically. EA is associated with a mixed flora and a higher rate of airway obstruction. Streptococcus is discovered to be the most common pathogen.
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Affiliation(s)
- Giorgos Sideris
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papadimitriou
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Georgios F Korres
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karaganis
- Department of Economic and Regional Development, Panteion University of Social and Political Sciences, Athens, Greece
| | - Pavlos Maragkoudakis
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Thomas Nikolopoulos
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Alexander Delides
- 2nd Otolaryngology Department, School of Medicine, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
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Ronen O. Ultrasound guided transcervical drainage of tongue base abscess. Am J Otolaryngol 2020; 41:102638. [PMID: 32659611 DOI: 10.1016/j.amjoto.2020.102638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
IMPORTANCE Infected vallecular cysts should first be treated conservatively and if airway is compromised surgical treatment is considered. OBJECTIVE The aim of this study was to determine the feasibility and safety of transcervical aspiration of an infected vallecular cyst. DESIGN A retrospective review of a novel technique that has been used for drainage of vallecular cyst abscesses for 5 years (2012 to 2017). SETTING Galilee Medical Center affiliated to Azrieli Faculty of Medicine. PARTICIPANTS Consecutive patients who underwent ultrasound guided percutaneous vallecular cyst drainage. MAIN OUTCOME & MEASURES Medical records were reviewed to identify patient characteristics, symptoms, and outcomes. RESULTS During 2012-2017, seven patients underwent transcutaneous ultrasound-guided drainage of a tongue-base abscess as an in-hospital office procedure. In all patients the technique described above was feasible. About a month after the procedure, patients underwent surgical marsupialization of the cyst under general anesthesia. CONCLUSIONS AND RELEVANCE Ultrasound guided transcutaneous needle drainage of a base of tongue abscess is possible as it may achieve palliation and obtain material for culture. In this first-described series we show this technique's feasibility. Physicians should be familiar with this technique as it can easily be done under ultrasound guidance in the clinic using local anesthesia, and culture may be obtained, airway obstruction relieved, and recovery facilitated.
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Jensen B, Nix E, Pillutla P, Cordero J. Gold laser removal of a large ductal cyst on the laryngeal surface of the epiglottis. Proc (Bayl Univ Med Cent) 2020; 34:146-147. [PMID: 33456180 DOI: 10.1080/08998280.2020.1814485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Laryngeal cysts are rare lesions of the larynx that are often described on incidental discovery. We report an unusual presentation of a large ductal cyst located on the laryngeal surface of the epiglottis. The patient presented with a low tone voice while displaying bilateral normal appearing vocal cords with normal mobility. Computed tomography scans and flexible laryngoscopy showed a round supraglottic mass approximately 2 cm in diameter on the right lateral laryngeal surface of the epiglottis. The mass was removed surgically during microsuspension laryngoscopy with excision of the mucocele utilizing a gold laser. Postoperatively, the patient's voice returned to baseline with no complications.
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Affiliation(s)
- Brooke Jensen
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Evan Nix
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Pranati Pillutla
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joehassin Cordero
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.,Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
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Olzowy B, Al-Nawas B, Havel M, Karbach J, Müller R. Calculated parenteral initial treatment of bacterial infections: Infections in the ear, nose, throat and mouth and jaw area. GMS INFECTIOUS DISEASES 2020; 8:Doc14. [PMID: 32373439 PMCID: PMC7186809 DOI: 10.3205/id000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the sixth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the antibacterial treatment of more severe infections of the ear, the nose, the throat and the maxillofacial region, including odontogenic and salivary gland infections.
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Affiliation(s)
| | - Bilal Al-Nawas
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Miriam Havel
- Klinik und Poliklinik für HNO-Heilkunde, Klinikum der Universität München, Munich, Germany
| | - Julia Karbach
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsmedizin Mainz, Germany
| | - Rainer Müller
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus Dresden, Germany
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9
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Videolaryngoscope-assisted coblation of epiglottic cysts. Eur Arch Otorhinolaryngol 2020; 277:1129-1132. [PMID: 31993766 DOI: 10.1007/s00405-020-05804-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aims to investigate the safety and effectiveness of videolaryngoscope-assisted coblation of epiglottic cysts (VACECs) under general anesthesia. METHODS Twenty-eight consecutive patients with epiglottic cysts (ECs), underwent VACECs in this prospective clinical series from January 2015 to March 2019. The pre-operative electronic flexible laryngoscopic or 70° rigid laryngeal endoscopic examination was carried out to assess the location and size of ECs. There was a periodical follow-up survey for all patients. RESULTS A total 28 of patients were enrolled, including 12 men and 16 women, with an average age of 55 (range 24-78). The patient's medical history ranged from half a month to 2 years. The size of the cyst arranged from 0.8 to 1.5 cm. All patients were cured without pharyngeal or systemic complications. No tooth loss occurred in five patients (17.9%) with loose anterior teeth. Specimen pathology confirmed the diagnosis in all patients. No recurrence was found after more than half a year's follow-up. CONCLUSIONS VACECs brings together the advantages of videolaryngoscope and coblation. It is a simple, safe and feasible procedure for patients with ECs and is worthy of clinical application.
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10
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Shemesh S, Marom T, Vaknine H, Tamir SO. Neisseria flavescens Infection in Atypical Multiple Vallecular Cysts. Indian J Otolaryngol Head Neck Surg 2019; 71:11-13. [PMID: 31741919 DOI: 10.1007/s12070-015-0871-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/24/2015] [Indexed: 11/29/2022] Open
Abstract
A 53 year-old female patient presented with symptoms of intermittent odynophagia and halitosis persisting for 2 months. Physical examination revealed bilateral lingual tonsillar cysts and multiple vallecular cysts with clear fluid. Laboratory studies were unremarkable. The patient underwent surgery, during which uncapping of the multiple vallecular cysts was performed, and multiple microbiological samples and biopsies were taken. After surgery, the patient had complete resolution of all her symptoms. Pathological results demonstrated lymphoepithelial cysts. Microbiological tests demonstrated an infection by Neisseria flavescens, which is a non-pathogenic commensal of the oropharynx, and has never been described as causing agent of infected vallecular cysts.
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Affiliation(s)
- Shay Shemesh
- 1Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, P.O. Box 5, 58100 Holon, Israel
| | - Tal Marom
- 1Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, P.O. Box 5, 58100 Holon, Israel
| | - Hananya Vaknine
- 2Institute of Pathology, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, 58100 Holon, Israel
| | - Sharon Ovnat Tamir
- 1Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, P.O. Box 5, 58100 Holon, Israel
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11
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Sideris A, Holmes TR, Cumming B, Havas T. A systematic review and meta-analysis of predictors of airway intervention in adult epiglottitis. Laryngoscope 2019; 130:465-473. [PMID: 31173373 DOI: 10.1002/lary.28076] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease. METHODS The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random-effects model meta-analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention. RESULTS Thirty studies and a total of 10,148 patients were finally included for meta-analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention. CONCLUSION In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention. LEVEL OF EVIDENCE NA Laryngoscope, 130:465-473, 2020.
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Affiliation(s)
- Anders Sideris
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Timothy R Holmes
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Benjamin Cumming
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Thomas Havas
- Department of Otolaryngology/Head and Neck Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia.,ORL Head and Neck Research Group, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
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12
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Tsai YT, Huang EI, Chang GH, Tsai MS, Hsu CM, Yang YH, Lin MH, Liu CY, Li HY. Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population-based case-control study. PLoS One 2018; 13:e0199036. [PMID: 29889887 PMCID: PMC5995441 DOI: 10.1371/journal.pone.0199036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/30/2018] [Indexed: 01/14/2023] Open
Abstract
Objective Studies have revealed that 3.5%–26.6% of patients with epiglottitis have comorbid diabetes mellitus (DM). However, whether preexisting DM is a risk factor for acute epiglottitis remains unclear. In this study, our aim was to explore the relationship between preexisting DM and acute epiglottitis in different age and sex groups by using population-based data in Taiwan. Methods We analyzed data between January 2000 and December 2013 obtained from the Taiwan National Health Insurance Research Database. The case group consisted of 2,393 patients with acute epiglottitis. The control group comprised 9,572 individuals without epiglottitis, frequency matched by sex, age, urbanization level, and income. Underlying DM was retrospectively assessed in the cases and controls. Univariate and multivariate logistic regression analyses were used to investigate the associations between underlying DM and acute epiglottitis. Results Of the 2,393 patients, 180 (7.5%) had preexisting DM, whereas only 530 (5.5%) of the 9,572 controls had preexisting DM. Multivariate logistic regression analyses indicated that preexisting DM was significantly associated with acute epiglottitis (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = 1.15–1.75, P = 0.004). Subgroup analysis showed that the association between DM and epiglottitis remained significant for men (aOR = 1.57, 95% CI: 1.19–2.08, p = 0.002) but not for women. Age-stratified analysis revealed a significant association between DM and acute epiglottitis in patients aged 35–64 years. Use of anti-diabetic agents was not significantly associated with the development of acute epiglottitis among diabetic patients, including oral hypoglycemic agents (OHA) alone (aOR = 0.88, 95% CI = 0.53–1.46, p = 0.616), and OHA combined with insulin/ insulin alone (aOR = 1.30, 95% CI = 0.76–2.22, p = 0.339). The association between presence of diabetes complications and the occurrence of acute epiglottitis was also not significant among diabetic patients in this study setting (aOR = 0.86, 95% CI = 0.59–1.26, p = 0.439). Conclusions The results of our large-scale population-based case–control study indicate that preexisting DM is one of the possible factors associated with the development of acute epiglottitis. Physicians should pay attention to the symptoms and signs of acute epiglottitis in DM patients, particularly in men aged 35–64 years.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ethan I. Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hsueh-Yu Li
- Department of Otolaryngology–Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail:
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Heyes R, Lott DG. Laryngeal Cysts in Adults: Simplifying Classification and Management. Otolaryngol Head Neck Surg 2017; 157:928-939. [DOI: 10.1177/0194599817715613] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Laryngeal cysts may occur at any mucosa-lined location within the larynx and account for 5% to 10% of nonmalignant laryngeal lesions. A number of proposed classifications for laryngeal cysts exist; however, no previously published classification aims to guide management. This review analyzes contemporary laryngeal cyst management and proposes a framework for the terminology and management of cystic lesions in the larynx. Data Sources PubMed/Medline. Review Methods A primary literature search of the entire Medline database was performed for all titles of publications pertaining to laryngeal cysts and reviewed for relevance. Full manuscripts were reviewed per the relevance of their titles and abstracts, and selection into this review was according to their clinical and scientific relevance. Conclusion Laryngeal cysts have been associated with rapid-onset epiglottitis, dyspnea, stridor, and death; therefore, they should not be considered of little significance. Symptoms are varied and nonspecific. Laryngoscopy is the primary initial diagnostic tool. Cross-sectional imaging may be required, and future use of endolaryngeal ultrasound and optical coherence tomography may revolutionize practice. Where possible, cysts should be completely excised, and there is growing evidence that a transoral approach is superior to transcervical excision for nearly all cysts. Histology provides definitive diagnosis, and oncocytic cysts require close follow-up. Implications for Practice A new classification system is proposed that increases clarity in terminology, with the aim of better preparing surgeons and authors for future advances in the understanding and management of laryngeal cysts.
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Affiliation(s)
- Richard Heyes
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David G. Lott
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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14
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Shapira Galitz Y, Shoffel-Havakuk H, Cohen O, Halperin D, Lahav Y. Adult acute supraglottitis: Analysis of 358 patients for predictors of airway intervention. Laryngoscope 2017; 127:2106-2112. [DOI: 10.1002/lary.26609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/08/2017] [Accepted: 03/06/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Yael Shapira Galitz
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery; University of Southern California; Los Angeles California U.S.A
| | - Oded Cohen
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
| | - Doron Halperin
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery; Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem; Israel
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15
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Hah JH, Sim S, An SY, Sung MW, Choi HG. Evaluation of the prevalence of and factors associated with laryngeal diseases among the general population. Laryngoscope 2015; 125:2536-42. [DOI: 10.1002/lary.25424] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/08/2015] [Accepted: 05/15/2015] [Indexed: 01/26/2023]
Affiliation(s)
- J. Hun Hah
- Department of Otorhinolaryngology-Head & Neck Surgery and Cancer Research Institute; Seoul National University, College of Medicine; Seoul Korea
| | - Songyong Sim
- Department of Statistics; Hallym University; Chuncheon Korea
| | - Soo-Youn An
- Department of Otorhinolaryngology-Head & Neck Surgery; Thyroid/Head & Neck Cancer Center of the Dongnam Institute of Radiological & Medical Sciences (DIRAMS); Busan Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head & Neck Surgery and Cancer Research Institute; Seoul National University, College of Medicine; Seoul Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery; Hallym University Sacred Heart Hospital; Anyang Korea
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16
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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.
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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
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17
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Suzuki S, Yasunaga H, Matsui H, Fushimi K, Yamasoba T. Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database. Laryngoscope 2014; 125:2072-8. [DOI: 10.1002/lary.25114] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/14/2014] [Accepted: 12/01/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Sayaka Suzuki
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
- Department of Otolaryngology and Head and Neck Surgery; Faculty of Medicine, The University of Tokyo; Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics; School of Public Health, The University of Tokyo; Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics; Tokyo Medical and Dental University Graduate School of Medicine; Tokyo Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery; Faculty of Medicine, The University of Tokyo; Tokyo Japan
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Chiu PH, Shih CW, Tsai YJ, Chiang RPY. Laryngeal Ultrasound for Assessment of Supraglottic Laryngitis with Abscess. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10023-1055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Here we report a rare case, for this era, of supraglottic laryngitis with abscess formation after antibiotics use. Laryngeal ultrasound for abscess detection and follow-up has advantages over neck computed tomography. This modality can assess vocal cord movement noninvasively with the benefits of cost effectiveness, easy availability, freedom from radiation, and high resolution-factors that are superior to other modalities. Although laryngeal abscesses are rare, clinicians should be aware of their myriad presentations. Acute supraglottitis with abscess formation may cause potentially fatal obstruction of the airway. Early recognition and intervention to prevent morbidity and mortality is thus very important.
How to cite this article
Chiu PH, Shih CW, Tsai YJ, Chiang RPY. Laryngeal Ultrasound for Assessment of Supraglottic Laryngitis with Abscess. Int J Phonosurg Laryngol 2013;3(1): 24-27.
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Sato S, Kuratomi Y, Inokuchi A. Pathological characteristics of the epiglottis relevant to acute epiglottitis. Auris Nasus Larynx 2012; 39:507-11. [DOI: 10.1016/j.anl.2011.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 10/26/2011] [Accepted: 10/29/2011] [Indexed: 10/15/2022]
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20
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Seo JH, Lee DH. Re: The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis. Clin Otolaryngol 2010; 35:238; author reply 238-9. [DOI: 10.1111/j.1749-4486.2010.02123.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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