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At least 19 recordsLinked to original sources
PubMedDate not supplied

The rising incidence of adult acute epiglottitis and epiglottic abscess.

OBJECTIVE: To examine preliminary observations that the incidence of adult acute epiglottitis has risen between 1986 and 2000. MATERIALS AND METHODS: Demographics, annual and seasonal occurrences, clinical presentation, diagnostic procedures, treatment, airway management, and complications of 116 consecutive adult patients with laryngoscopically confirmed acute epiglottitis are presented. RESULTS: The mean annual incidence of acute epiglottitis per 100,000 adults significantly increased from 0.88 (from 1986-1990) to 2.1 (from 1991-1995) and to 3.1 (from 1996-2000) (P <.001). This rise seems to be unrelated to Haemophilus influenzae type b infection but related to miscellaneous pathogenic bacteria. During these periods, the number of epiglottic abscesses increased concomitantly with the rise in the incidence of acute epiglottitis (from 4/14 episodes [29%], to 8/38 [21%], and to 16/66 [24%], respectively), showing a relatively constant ratio between both phenomena (P =.843). Twenty-five patients (21%) underwent airway intervention, 16 because of objective respiratory distress and 9 because of imminent respiratory obstruction. Stepwise logistic regression showed that drooling, diabetes mellitus, rapid onset of symptoms, and abscess formation were associated with airway obstruction. Diverse origins for the epiglottic abscess, either from coalescent epiglottic infection or from mucopyocele of the tongue base, are suggested. CONCLUSIONS: A rise in the incidence of acute epiglottitis and a concomitant rise in the number of epiglottic abscesses were established. Although the course of acute epiglottitis is often benign and can be safely treated with a conservative management approach, delayed airway obstruction may develop from a few hours to days after admission.

Abscess↗
PubMed2002

Epiglottic dysfunction: abnormal epiglottic movement patterns.

Epiglottic movement patterns of 500 consecutive patients with varying etiologies were recorded during routine videofluoroscopic swallow evaluations. Seven distinct, commonly repeated, abnormal epiglottic patterns were identified. A multifactorial analysis of these seven abnormal epiglottic movement patterns was completed. Findings indicate that each of these seven distinct movement patterns have varying rates and amounts of aspiration. A description of each epiglottic movement pattern is given in conjunction with information regarding aspiration and other variables associated with the swallow process. A universal nomenclature is offered regarding these subtle abnormal epiglottic movement patterns to increase a verbal commonality in our descriptions of epiglottic function as it affects aspiration.

Adolescent↗
PubMed1991

Correlation of performance with endoscopic and radiographic assessment of epiglottic hypoplasia in racehorses with epiglottic entrapment corrected by use of contact neodymium:yttrium aluminum garnet laser.

Epiglottic entrapment in 35 Thoroughbred and 44 Standardbred horses was corrected transendoscopically by use of a neodymium:yttrium aluminum garnet laser. Before surgery, the entrapped epiglottis was classified as hypoplastic or normal in each horse on the basis of endoscopic appearance alone. Using a digitizer, thyroepiglottic length was determined from lateral-view laryngeal radiographs. For 78 racehorses, earnings (less than $5,000 or greater than $5,000) were compared before and after surgery. Earnings category and racing performance after surgery were tested for association with endoscopically determined epiglottic hypoplasia and radiographically determined thyroepiglottic length. Endoscopy and radiography were useful methods of evaluating the epiglottis in horses with epiglottic entrapment. Mean (+/- SD) thyroepiglottic length for both breeds of horses with epiglottic entrapment was significantly (P = 0.0001) smaller (Thoroughbreds, 7.28 +/- 0.67 cm; Standardbreds, 7.21 +/- 0.62 cm), compared with thyroepiglottic length measured from control groups composed of clinically normal Thoroughbred (8.56 +/- 0.29 cm) and Standardbred (8.74 +/- 0.38 cm) racehorses. Both breeds of horses with epiglottic entrapment that had endoscopically apparent hypoplastic epiglottis had significantly (P less than 0.0001) smaller thyroepiglottic length (Thoroughbreds, 6.64 +/- 0.60 cm; Standardbred, 6.93 +/- 0.72 cm) than did horses with epiglottic entrapment that had endoscopically normal epiglottis (Throughbreds, 7.57 +/- 0.47 cm, Standardbreds, 7.36 +/- 0.50 cm). Significant difference was not detected in endoscopic appearance of the epiglottis among age, gender, or breed distributions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Epiglottitis in horses: 20 cases (1988-1993).

Epiglottitis was diagnosed and treated in 20 horses (13 Thoroughbreds and 7 Standardbreds) over a 5-year period. Eighteen horses were used for racing, and 2 Standardbreds were broodmares. Primary clinical signs were exercise intolerance, respiratory noise, and coughing. The most common endoscopic diagnosis made by referring veterinarians was epiglottic entrapment (11 horses). In 19 horses, endoscopic evaluation at admission revealed mucosal ulceration and thickening of the lingual surface of the epiglottis. Other endoscopic findings included dorsal displacement of the soft palate (14 horses), and dorsal deviation of the epiglottic axis (11 horses). Only 1 horse had epiglottic entrapment. Treatment consisting of stall confinement for 7 to 14 days, topical administration of a solution of furacin, dimethyl sulfoxide, glycerin, and prednisolone, and systemic administration of nonsteroidal anti-inflammatory drugs and corticosteroids was effective in controlling epiglottic edema and inflammation. Antimicrobials were administered to 6 horses. Racing performance of the 18 racehorses was evaluated by examination of racing records. One horse was still convalescing at the time of the study, and 1 horse had been euthanatized 1 week after treatment for epiglottitis because of colic. The remaining 16 horses all started at least 1 race (mean time between initial examination and start of first race, 74 days; range, 8 to 265 days). Thirteen horses started at least 4 races following treatment for epiglottitis; racing performance after treatment was the same in 8 and decreased in 5. Long-term sequelae of epiglottitis included epiglottic deformity (5 horses), intermittent or persistent dorsal displacement of the soft palate (4 horses), and epiglottic entrapment (1 horse).

Animals↗
PubMed1991

Evaluation of epiglottic augmentation by use of polytetrafluoroethylene paste in horses.

Epiglottic augmentation was evaluated in 7 horses, using 7 ml of polytetrafluoroethylene (polytef) paste injected submucosally on the ventral surface of the epiglottis. In 6 horses, an Arnold-Bruning intracordal injection syringe, specifically designed to inject polytef into paralyzed vocal folds in human beings, was used. At necropsy 60 days after surgery, group mean thickness measurement 20 mm from the epiglottic tip was 40% greater (P less than 0.01) and, at the epiglottic attachment of the aryepiglottic fold, was 29% greater (P less than 0.01) in the 6 polytef-augmented horses than in clinically normal nonsurgically treated controls. At necropsy, extensive epiglottic thickening was seen. This thickening was exclusively attributable to distention of submucosal areas in the ventral aspect of the epiglottis, with foreign body granulomata surrounded by fibrous connective tissue. In 1 horse, polytef paste was injected by use of a disposable syringe and needle. Excess ventral epiglottic swelling and exposed epiglottic cartilage was seen during subsequent endoscopy. At necropsy 60 days after surgery, the epiglottic contour remained deformed and a large deep mucosal ulcer was observed at the injection site. Histologic examination revealed necrotizing suppurative inflammation that extended into the epiglottic cartilage. Surgery was not technically difficult to perform through a laryngotomy, and all horses tolerated the procedure without apparent discomfort. Endoscopy performed after surgery revealed unremarkable and uniform response to the polytef paste in 4 horses, and in 3 horses, revealed excess swelling and inflammation of the ventral epiglottic tissue that resolved over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Paediatric acute epiglottitis: not a disappearing entity.

OBJECTIVE: Paediatric epiglottitis is a serious, potentially life-threatening condition. Since the widespread introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine in the UK in October 1992, there has been a dramatic reduction in its incidence. Vaccine failure is rare. The purpose of this study is to examine the failure rate of H. influenzae type b vaccine as measured by the number of cases of Haemophilus epiglottitis in fully vaccinated children presenting to a tertiary paediatric centre. A secondary aim is to provide a retrospective review of all cases of epiglottitis over a 13-year period. METHODS: A retrospective case-note review identifying all cases of epiglottitis presenting to Alder Hey Hospital was undertaken covering the time period December 1987-January 2001. Details of patient age, sex, source of referral, clinical presentation, management and complications along with microbiological and serological findings were obtained. There were 21 males and 19 females. The mean age was 36 months (range 6-125 months). A provisional diagnosis was made on the basis of the clinical features, confirmed by direct laryngoscopy in all but two cases and further supported in 28 cases by a positive blood culture. Of the 40 children presenting with epiglottitis, eight (20%) presented after the introduction of the Hib conjugate vaccine. H. influenzae antibody titres were measured both in the acute and convalescent phases of illness by the central Haemophilus Reference Unit in Oxford. RESULTS: We present the clinical features, management and complications of 40 cases of acute epiglottitis. H. influenzae was isolated from blood cultures in 28 cases (70%). In 12 of these cases, H. influenzae type b was identified, seven prior to 1993 and five thereafter. Four of these five cases presenting after introduction of the Hib vaccine were known to have been fully vaccinated. One child had a history of prematurity and serum immunoglobulin estimation was abnormally low in another child. Acute Hib antibody titre was less than 1 microg/ml in two of the three cases in which this was available. CONCLUSION: Whilst the incidence of Haemophilus type b epiglottitis has significantly diminished, vaccine failure does occur. We discuss the current understanding of clinical and immunological risk factors for vaccine failure and the significance of the Hib antibody titre. Further evaluation of vaccine failure would be of benefit. The series that we present highlights the importance of considering acute epiglottitis in the differential diagnosis of the child presenting with acute upper airway obstruction. This is particularly relevant when in future there will be fewer doctors familiar with the symptoms and signs of the disease.

Acute Disease↗
PubMed1990

Radiologic diagnosis of epiglottitis: objective criteria for all ages.

A retrospective study was undertaken to define objective radiologic parameters in diagnosing epiglottitis on soft-tissue lateral neck radiographic studies. Ratios of soft-tissue structures in 31 patients aged 7 months to 61 years with epiglottitis were compared with those of age- and sex-matched controls with croup, pharyngitis, and dysphagia. The ratios of epiglottic width to third cervical vertebral body width (EW/C3W) of more than 0.5, of aryepiglottic width to third cervical vertebral body width (AEW/C3W) of more than 0.35, and of epiglottic width to epiglottic height (EW/EH) of 0.6 or more were all found to be 100% sensitive and specific in differentiating between adult patients with and without epiglottitis. In children, EW/C3W, AEW/C3W, and EW/EH ratios of more than 0.5, of more than 0.35, and of 0.6 or more, respectively, were found to be 100% sensitive in detecting epiglottitis with specificities of 87%, 96%, and 87% respectively. These preliminary results suggest that EW/C3W, EW/EH, and AEW/C3W ratios of more than 0.5, of 0.6 or more, and of more than 0.35, respectively, may be useful in the radiologic diagnosis of epiglottitis in patients of all ages.

Adolescent↗
PubMed1990

Transendoscopic contact neodymium:yttrium aluminum garnet laser correction of epiglottic entrapment in standing horses.

Fifty-seven Standardbred and 44 Thoroughbred racehorses and 1 Thoroughbred polo mare with primary clinical signs of exercise intolerance or respiratory tract noise or combined exercise intolerance and respiratory tract noise were referred for laser correction of epiglottic entrapment. Significantly (P less than 0.001) more Standardbred than Thoroughbred racehorses were affected, compared with the observed hospital population during the same period. At referral, 14 horses did not have evident epiglottic entrapment and were returned to exercise without development of entrapment after treatment, which consisted of 1 week of rest and administration of anti-inflammatory medication. In 88 standing horses under sedation and topical anesthesia, epiglottic entrapment was corrected transendoscopically by use of a contact neodymium:yttrium aluminum garnet laser. In these 88 horses, 98% of entrapments were persistent, 92% were thick, 97% were wide, and 45% were ulcerated. Thirty-one percent of the horses had endoscopic evidence of epiglottic hypoplasia, and 8% had deviated epiglottic axis. Complete correction was achieved in 97% of the horses, Persistent dorsal displacement of the soft palate in 1 horse and severe epiglottic hypoplasia with thick, chronic entrapping membranes in 2 horses precluded successful transendoscopic correction with the horses in standing position. Most horses were treated on an outpatient basis, and all were able to be returned to exercise after 7 to 14 days of rest and treatment with anti-inflammatory medication. Entrapment recurred in 4 horses (5%), 3 of which had hypoplastic epiglottis. Dorsal displacement of the soft palate developed after surgery in 9 horses (10%) and continued in 4 horses (5%) that had displaced soft palate before surgery. All these horses had epiglottic hypoplasia. Laser correction of epiglottic entrapment in standing horses was safe, well tolerated, and effective. Laser surgery was an alternative to conventional surgery, and eliminated the need for general anesthesia and laryngotomy. It also reduced convalescence and postoperative complications.

Airway Obstruction↗
PubMed1994

Surgical treatment for epiglottic entrapment in horses: 51 cases (1981-1992).

Medical records of 51 horses with epiglottic entrapment were reviewed, and the outcome after surgical treatment was evaluated by use of results from a survey of owners and from race records. Horses with epiglottic entrapment and no additional problem (uncomplicated) of the nares, nasal passages, pharynx, or larynx (upper airway) that were treated by transoral axial division (group 1) or resection via laryngotomy (group 2), and horses with epiglottic entrapment complicated by an additional upper airway abnormality (group 3) were compared. The cost of treatment, duration of hospitalization, time to first race start after surgery, and complication rate were significantly (P < 0.05) less in horses in group 1, compared with those in horses of group 2. Owner survey indicated that a significantly greater percentage (82%) of horses in group 1 had a successful outcome after transoral axial division, compared with that (27%) of horses in group 2. Analysis of race records indicated that performance was similar between horses in groups 1 and 2, and significantly more horses with an additional upper airway lesion (group 3) failed to return to racing than did horses with uncomplicated epiglottic entrapment (groups 1 and 2). Transoral axial division of the ary-epiglottic fold is recommended as an appropriate treatment for uncomplicated epiglottic entrapment. Resection via laryngotomy should be reserved for treatment of epiglottic entrapment associated with excessively thick and scarred aryepiglottic folds and for intermittent epiglottic entrapment in horses for which surgical correction is deemed appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Haemophilus influenzae type B epiglottitis after immunization with HbOC conjugate vaccine.

INTRODUCTION: US Food and Drug Administration (USFDA) has licensed four Haemophilus influenzae type B (Hib) vaccines for use in children. Haemophilus influenzae type B is by far the most common pathogen in childhood epiglottitis and it is hoped that with the introduction of the Hib vaccine that a corresponding decrease in epiglottitis cases will be appreciated. MATERIALS AND METHODS: A retrospective study of all children admitted with the diagnosis of epiglottitis for the 11-year period of 1982 to 1992 was conducted in order to determine the incidence of epiglottitis and Hib vaccine failure. Fifty-nine cases were included in the study by documentation of an inflamed epiglottis. The case of Hib epiglottitis in a 4-year-old child immunized with HbOC conjugate vaccine at 18 months of age is detailed. RESULTS: A statistically significant decrease was found in the incidence of epiglottitis since introduction of the vaccines; however, the overall trend in decrease for the 11-year period was not statistically significant. Vaccination status was difficult to accurately document with only two cases of vaccine failure identified. CONCLUSION: The incidence of Haemophilus influenzae type B epiglottitis at our regional Children's hospital has decreased since the introduction of the Hib vaccine. Reasons for vaccine failure are postulated.

Bacterial Proteins↗
PubMed1996

Unique case presentations of acute epiglottic swelling and a protocol for acute airway compromise.

Acute epiglottitis is a well-described life-threatening disease. Since the generalized use of the Haemophilus influenzae type B (HIB) vaccine, presentations of this disorder have decreased dramatically in children. Presentations of this and other acute epiglottic swelling can vary remarkably and may easily be misdiagnosed by physicians who have little or no experience with the acutely obstructed airway. Early suspicion and a proper evaluation is mandatory to prevent a life-threatening crisis. Six patients are presented with unusual presentations of acute epiglottic swelling from differing etiologies; these include the following: case 1, recurrent epiglottitis; case 2, chronic epiglottitis; case 3, traumatic epiglottitis; case 4, caustic ingestion; and cases 5 and 6, simultaneous infection of family members. Because the incidence of acute epiglottitis is decreasing, it has become rare at most institutions. To help primary care and emergency room physicians, a formal written protocol should be available at medical facilities that might be faced with patients presenting with acute airway obstruction. An "acute airway obstruction protocol" used successfully for the last decade is offered. Use of such a written document might be life-saving for patients with impending upper airway obstruction. The otolaryngologist is a key member of the recommended multidisciplinary team.

Acute Disease↗
PubMed2005

Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease.

BACKGROUND: Acute epiglottitis due to infection with Haemophilus influenzae type b (Hib) is much less common in children following the introduction of Hib vaccination; however, adult epiglottitis cases have not decreased. In addition, epiglottitis hospitalizations are consistently more numerous than notifications and the reason for this is not clear. AIMS: To more accurately describe the clinical, aetiological and epidemiological features of epiglottitis and to ascertain the accuracy of hospitalization data in an era of widespread Hib vaccination. METHODS: Medical records in 11 public hospitals in three area health services in New South Wales with a principal or stay diagnosis (International Classification of Diseases (ICD)-9-CM or ICD-10-AM code) of acute epiglottitis between July 1990 and June 1992 (prior to Hib vaccination = pre-vaccine era) and July 1998 and June 2000 (widespread Hib vaccination = vaccine era) were reviewed. Case definitions of epiglottitis were applied. RESULTS: One hundred and forty-two records were identified (114 pre-vaccine era and 28 vaccine era). Incorrect coding was more common in vaccine era records (32 vs 7%). Of correctly coded records, adults over 20 years old comprised the majority in the vaccine era (84 vs 17%). Hib bacteraemia was identified in 62% of cases in the pre-vaccine era compared to no cases in the vaccine era, despite equivalent blood cultures being taken between the two eras (84 vs 74%). Streptococcus pneumoniae was the only other organism isolated. Three deaths were recorded (1 child, 2 adults), all in the pre-vaccine era. CONCLUSIONS: Acute epiglottitis hospitalizations in the current Hib vaccine era are predominantly in adults, and rarely are Hib or other causative organisms identified, although microbiological data are often incomplete. The discrepancy between hospitalization and notification data appears to be due to misclassification of hospitalization records.

Acute Disease↗
PubMed1992

A changing pattern of epiglottitis.

A case review of epiglottitis at Geisinger Medical Center over the past 12 years demonstrates a decrease in the number of pediatric patients with epiglottitis and an increase in the number of adults with epiglottitis. In the last five years, the number of epiglottitis patients younger than 10 years has fallen (0 cases), while the number of patients over 10 years of age has increased (6 cases). The cause of epiglottitis, Hemophilus influenzae type b, remains constant in the pediatric as well as in the adult population. There appears to be an increasing frequency of epiglottitis in adults and a decreasing frequency of epiglottitis in children.

Adult↗