Acute Epiglottitis in Adults

The analysis of 22 adult patients with acute epiglottitis, which we experienced during 7 and a half years, was reported. The sex ratio was 7:3 (M:F), and mean age was 39.5 years old. The majority of the cases complained of odynophagia, sore throat and dysphagia. Only 2 patients complained of dyspnea, which appeared 2 or 3 days after the onset of odynophagia. Typical findings of the epiglottis were injection and swelling. However, 3 cases showed pale and edematous epiglottis, which was supposed to reflect sudden obstruction of lymph flow. Xeroradiography of the lateral neck provided an excellent diagnostic clue, which consisted of swelling of the epiglottis (thumb-print sign), aryepiglottic folds and arytenoids. Although a blood culture is the only unequivocal method of documenting a responsible pathogen, we could not identify any organism. The protocol of the management should be 1) instant admission, 2) antibiotic therapy-ampicillin is the first choice, and 3) close observation. In patients with respiratory distress, endotracheal intubation and inhalation of humidified oxygen should be a useful adjunct. However, we had to treat half of the patients without admission for some reasons. All of these patients had an uneventful course without eatablishing artificial airway patency. Acute epiglottitis in adults is not rare. It is preferable to diagnose as acute epiglottitis for every patient with sore throat accompanied with dysphagia until proven otherwise.