This presentation describes the anatomy, aetiology , examination and treatment of acute epiglottits in a simplified form. :)

1. ACUTE
EPIGLOTTITS

2. • Leaf like, yellow, elastic
cartilage forming anterior wall
of laryngeal inlet.
• Attached to body of hyoid bone
by hyoepiglottic ligament
(dividing it into supra hyoid &
infra hyoid epiglottis).
• Anterior surface of epiglottis is
separated from thyrohyoid
membrane & upper part of
thyroid cartilage by a potential
space filled with fat— the pre-
epiglottic space .
• Space can be invaded in
carcinoma of supraglottic
larynx or base of tongue.
ANATOMY

3. Supraglottic structures, eg epiglottis,
aryepiglottic folds and arytenoids.

4. Definition: Acute
inflammatory condition
confined to supraglottic
structures:-
-epiglottis
-aryepiglottic folds
-arytenoids
There is marked oedema of
these structures which may
obstruct the airway.
ACUTE EPIGLOTTITIS (SYN.
SUPRAGLOTTIC LARYNGITIS)

5. Classically
described as a
Haemophilus
influenzae type B
bacterial infection
of the epiglottis in
children.
In adults only 20%
of epiglottitis is
caused by
Haemophilus
influenzae. Figure 3.0: Organisms that can cause acute
epiglottitis in adults.
AETIOLOGY:

6. • Odynophagia
• Inability to swallow secretions
• Sore throat
• Muffled voice-“hot potato voice”
• Hoarseness
• Cough
• Dyspnoea
• Rising sun sign- “angry red epiglottis”
• Respiratory distress
SYMPTOMS

7. • Fever (>37.2 °C)
• Tachycardia (100 bpm)
• Pharyngitis
• Swelling of the epiglottis
• Cervical lymph nodes
• Swelling of supraglottic tissue
• Inspiratory stridor
• Drooling/inability to handle secretion
SIGNS

8. • Depressing the tongue with a tongue
depressor may show red & swollen epiglottis.
• Indirect laryngoscopy may show oedema &
congestion of supraglottic structures. This
examination is avoided for fear of
precipitating complete obstruction (better
done in OT where facilities for intubation are
available).
EXAMINATION

9. • Lateral soft tissue X-ray of neck may show swollen epiglottis (thumb sign)
• CT & MRI :-
Helpful to evaluate the complications of this disorder ,such as :
-abscess formation
-thickening of the epiglottis,
-obliteration of the pre-epiglottic fat ;&
-thickening of the subcutaneous tissue and muscles are common radiological
findings in epiglottic abscess

11. A lateral soft-tissue radiograph
of the neck showed a “thumb
sign” (arrow). This radiographic
sign is a manifestation of an
enlarged and edematous
epiglottis, and it suggests a
diagnosis of acute infectious
epiglottitis.

12. DIFFERENTIAL DIAGNOSIS
INFECTIOUS DISEASES NON-INFECTIOUS DISEASES
• Mononucleosis
• Diphtheria
• Pertussis
• Croup
• Tonsillitis
• Subglottic laryngitis
• Allergic reactions
• Angioneurotic oedema
• Foreign body aspiration
• Reflex laryngospasm
• Laryngeal trauma
• Tumours
• Hydrocarbon aspiration
• SLE
• Inhalation of toxic fumes or
superheated steam

13. In some cases, an infection can spread from the
epiglottis to nearby parts of the body, including
the:
• Inner ear (otitis media)
• Brain (meningitis)
• Heart lining (pericarditis)
• Lungs (pneumonia)
• Cervical adenitis
• Epiglottic abscess
COMPLICATIONS

14. 1. Hospitalisation -essential because of the danger of respiratory
obstruction
2. Antibiotics -Ampicillin
-Third generation cephalosporin
(i) effective against
H.influenzae
(ii) given by parenteral route
(i.m/i.v)
3. Steroids -hydrocortisone/dexamethasone (i.m/i.v)
4. Adequate hydration -parenteral fluids
5. Humidification and oxygen
6. Intubation or tracheostomy -respiratory obstruction
TREATMENT

15. Algorithm for management
of epiglottitis

16. Source: Acute Adult Supraglottitis: Current Management and Treatment Mohannad Al-Qudah, MD, FAAOHNS, Shetty, S. MD, M.
Alomari, MD, Maen Alqdah, FRCPC, FCCP South Med J. 2010;103(8):800-804.-Medscape-

17. 1.The prognosis in adults with acute epiglottitis is good with
appropriate and timely treatment.
2.Most patients can be extubated within several days.
3.However, unrecognised epiglottitis may rapidly lead to airway
compromise and resultant death.
4.In spite of acute epiglottitis generally having a good prognosis,
the risk of death for persons is high due to sudden airway
obstruction and difficulty intubating patients with extensive
swelling of supraglottic structures.
5.Reported cases do include sudden fatal cardiorespiratory
arrest occurring in patients without previous evidence of
respiratory obstruction while in an intensive care unit (ICU)
setting, emphasising the importance of providing close
monitoring and adequate airway protection in these patients.
The adult mortality rate is around 7%.
PROGNOSIS