Epiglottitis (supraglottitis): Management
- Charles R Woods, MD, MS
Charles R Woods, MD, MS
- Professor of Pediatrics
- University of Louisville School of Medicine
- Section Editors
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The treatment and prevention of epiglottitis will be reviewed here. The clinical features and diagnosis of epiglottitis are discussed separately. (See "Epiglottitis (supraglottitis): Clinical features and diagnosis".)
Epiglottitis is inflammation of the epiglottis and adjacent supraglottic structures . Without treatment, epiglottitis can progress to life-threatening airway obstruction. A rapid overview of the recognition and management of epiglottitis in children is provided in the table (table 1).
Maintenance of the airway is the mainstay of treatment of patients with epiglottitis. In patients with signs of total or near-total airway obstruction, airway control necessarily precedes diagnostic evaluation. The diagnostic evaluation of epiglottitis in children and adults is discussed in detail separately. (See "Epiglottitis (supraglottitis): Clinical features and diagnosis", section on 'Diagnostic criteria'.)
Epiglottitis should be suspected in young children, especially those who are un- or under-immunized against Haemophilus influenzae, type b (Hib) and who present with the characteristic clinical features as follows:
●"Tripod" position (picture 1)
- Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am 2006; 53:215.
- Sobol SE, Zapata S. Epiglottitis and croup. Otolaryngol Clin North Am 2008; 41:551.
- Andreassen UK, Baer S, Nielsen TG, et al. Acute epiglottitis--25 years experience with nasotracheal intubation, current management policy and future trends. J Laryngol Otol 1992; 106:1072.
- Andreassen UK, Husum B, Tos M, Leth N. Acute epiglottitis in adults. A management protocol based on a 17-year material. Acta Anaesthesiol Scand 1984; 28:155.
- Stroud RH, Friedman NR. An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. Am J Otolaryngol 2001; 22:268.
- Cantrell RW, Bell RA, Morioka WT. Acute epiglottitis: intubation versus tracheostomy. Laryngoscope 1978; 88:994.
- Schloss MD, Hannallah R, Baxter JD. Acute epiglottitis: 26 years' experience at the Montreal Children's Hospital. J Otolaryngol 1979; 8:259.
- Schuller DE, Birck HG. The safety of intubation in croup and epiglottitis: an eight-year follow-up. Laryngoscope 1975; 85:33.
- Heldtander P, Lee P. Treatment of acute epiglottitis in children by long-term intubation. Acta Otolaryngol 1973; 75:379.
- Allen TH, Steven IM. Prolonged nasotracheal intubation in infants and children. Br J Anaesth 1972; 44:835.
- Cherry JD. Epiglottitis (supraglottitis). In: Textbook of Pediatric Infectious Diseases, 6th, Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL. (Eds), Saunders, Philadelphia 2009. p.244.
- Mayo-Smith MF, Spinale JW, Donskey CJ, et al. Acute epiglottitis. An 18-year experience in Rhode Island. Chest 1995; 108:1640.
- Berger G, Landau T, Berger S, et al. The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Otolaryngol 2003; 24:374.
- Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol 2005; 119:967.
- Solomon P, Weisbrod M, Irish JC, Gullane PJ. Adult epiglottitis: the Toronto Hospital experience. J Otolaryngol 1998; 27:332.
- Deeb ZE, Yenson AC, DeFries HO. Acute epiglottitis in the adult. Laryngoscope 1985; 95:289.
- Damm M, Eckel HE, Jungehülsing M, Roth B. Airway endoscopy in the interdisciplinary management of acute epiglottitis. Int J Pediatr Otorhinolaryngol 1996; 38:41.
- McEwan J, Giridharan W, Clarke RW, Shears P. Paediatric acute epiglottitis: not a disappearing entity. Int J Pediatr Otorhinolaryngol 2003; 67:317.
- Trollfors B, Nylén O, Strangert K. Acute epiglottitis in children and adults in Sweden 1981-3. Arch Dis Child 1990; 65:491.
- Hébert PC, Ducic Y, Boisvert D, Lamothe A. Adult epiglottitis in a Canadian setting. Laryngoscope 1998; 108:64.
- Ng HL, Sin LM, Li MF, et al. Acute epiglottitis in adults: a retrospective review of 106 patients in Hong Kong. Emerg Med J 2008; 25:253.
- Chang YL, Lo SH, Wang PC, Shu YH. Adult acute epiglottitis: experiences in a Taiwanese setting. Otolaryngol Head Neck Surg 2005; 132:689.
- Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol 2008; 122:818.
- Frantz TD, Rasgon BM, Quesenberry CP Jr. Acute epiglottitis in adults. Analysis of 129 cases. JAMA 1994; 272:1358.
- Dort JC, Frohlich AM, Tate RB. Acute epiglottitis in adults: diagnosis and treatment in 43 patients. J Otolaryngol 1994; 23:281.
- Gerrish SP, Jones AS, Watson DM, Wight RG. Adult epiglottitis. Br Med J (Clin Res Ed) 1987; 295:1183.
- Ward MA. Emergency department management of acute respiratory infections. Semin Respir Infect 2002; 17:65.
- Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenzae type B vaccine era: changing trends. Laryngoscope 2004; 114:557.
- Asher MI. Infections of the upper respiratory tract. In: Pediatric Respiratory Medicine, Taussig LM, Landau LI. (Eds), Mosby, St. Louis 1999. p.540.
- Shah SS, Hopkins PM, Newland JG. Middle respiratory tract infections and bronchiolitis. In: Comprehensive Pediatric Hospital Medicine, Zaoutis LB, Chiang WV. (Eds), Mosby, Philadelphia 2007. p.369.
- Baxter FJ, Dunn GL. Acute epiglottitis in adults. Can J Anaesth 1988; 35:428.
- Glynn F, Fenton JE. Diagnosis and management of supraglottitis (epiglottitis). Curr Infect Dis Rep 2008; 10:200.
- DiTirro FR, Silver MH, Hengerer AS. Acute epiglottitis: evolution of management in the community hospital. Int J Pediatr Otorhinolaryngol 1984; 7:145.
- Kyrcz RW, Indyk D. Atypical acute epiglottitis with gastrointestinal bleeding. J Fam Pract 1988; 27:102.
- Battaglia JD, Lockhart CH. Management of acute epiglottitis by nasotracheal intubation. Am J Dis Child 1975; 129:334.
- Ladhani SN, Davila S, Hibberd ML, et al. Association between single-nucleotide polymorphisms in Mal/TIRAP and interleukin-10 genes and susceptibility to invasive haemophilus influenzae serotype b infection in immunized children. Clin Infect Dis 2010; 51:761.
- Nakamura H, Tanaka H, Matsuda A, et al. Acute epiglottitis: a review of 80 patients. J Laryngol Otol 2001; 115:31.
- Corbett HJ, Mann KS, Mitra I, et al. Tracheostomy--a 10-year experience from a UK pediatric surgical center. J Pediatr Surg 2007; 42:1251.
- Fleisher GR. Infectious disease emergencies. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.783.
- Stack BC Jr, Ridley MB. Epiglottic abscess. Head Neck 1995; 17:263.
- Reed J, Shah RK, Jantausch B, Choi SS. Aryepiglottic abscess manifesting as epiglottitis. Arch Otolaryngol Head Neck Surg 2009; 135:953.
- Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope 1990; 100:183.
- Cable BB, Biega T. Radiology forum. Quiz case 1. Adult epiglottitis with epiglottic abscess. Arch Otolaryngol Head Neck Surg 2001; 127:212, 214.
- Molteni RA. Epiglottitis: incidence of extraepiglottic infection: report of 72 cases and review of the literature. Pediatrics 1976; 58:526.
- Schuh S, Huang A, Fallis JC. Atypical epiglottitis. Ann Emerg Med 1988; 17:168.
- Tebruegge M, Connell T, Kong K, et al. Necrotizing epiglottitis in an infant: an unusual first presentation of human immunodeficiency virus infection. Pediatr Infect Dis J 2009; 28:164.
- Kong MS, Engel SH, Zalzal GH, Preciado D. Necrotizing epiglottitis and hemophagocytic lymphohistiocytosis. Int J Pediatr Otorhinolaryngol 2009; 73:119.
- Sengör A, Willke A, Aydin O, et al. Isolated necrotizing epiglottitis: report of a case in a neutropenic patient and review of the literature. Ann Otol Rhinol Laryngol 2004; 113:225.
- Kucera CM, Silverstein MD, Jacobson RM, et al. Epiglottitis in adults and children in Olmsted County, Minnesota, 1976 through 1990. Mayo Clin Proc 1996; 71:1155.
- Torkkeli T, Ruoppi P, Nuutinen J, Kari A. Changed clinical course and current treatment of acute epiglottitis in adults a 12-year experience. Laryngoscope 1994; 104:1503.
- APPROACH TO AIRWAY MANAGEMENT
- Immediately manage the airway and involve airway specialists
- Patient not able to maintain airway
- - Bag-valve-mask ventilation
- - Oxygenation not maintained
- - Oxygenation maintained
- Patient able to maintain airway
- ANTIMICROBIAL THERAPY
- ADDITIONAL THERAPIES
- ONGOING CARE
- ADDITIONAL EVALUATION
- SUMMARY AND RECOMMENDATIONS