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会厌炎(声门上炎)：临床特征和诊断

Author
Charles R Woods, MD, MS
Section Editors
Morven S Edwards, MD
Glenn C Isaacson, MD, FAAP
Gary R Fleisher, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
李春晖, 副主任医师，副教授

引言

会厌炎(也称声门上炎)的发病机制、病因和临床特征总结在此，会厌炎的治疗和预防将单独讨论。 (参见“会厌炎(声门上炎)：治疗和预防”)

定义

会厌炎是指会厌和与其毗邻的声门上结构出现炎症[1]。如不治疗，会厌炎可进展为危及生命的气道梗阻。表中简要概括了儿童会厌炎的识别和处理(表 1)。

解剖结构

会厌构成舌根下方会厌谷腔的后壁(图 1)，并通过韧带连于甲状软骨和舌骨。会厌由一片薄软骨组成，前部覆盖有复层鳞状上皮细胞层。鳞状细胞层也覆盖了后部表面的上1/3，并移行为延伸到喉部的呼吸道上皮。上皮层和下面的固有层紧紧附着在后(喉部)表面，并松弛地连于前(舌部)表面，因此舌面形成了一个可聚集水肿液体的潜在腔隙。

发病机制

感染性会厌炎是会厌、杓状会厌襞和其他毗邻组织的蜂窝织炎，由菌血症和/或病原微生物直接侵袭上皮层导致[2,3]。会厌炎的病原体主要来源于后方的鼻咽。上皮表面的显微镜下创伤(如病毒感染或食物吞咽过程导致的黏膜损伤)可能是易感因素。

会厌肿胀的原因是鳞状上皮层和会厌软骨之间的潜在腔隙出现水肿和炎症细胞聚集。会厌的舌面和会厌周围组织含有丰富的淋巴和血管网，易导致感染蔓延及随后的炎症反应。一旦出现感染，肿胀就会迅速进展到整个声门上喉(包括杓状会厌襞和杓状软骨)[3,4]。声门下区通常不受累，声带水平紧密附着的上皮阻止了肿胀扩张。

                              

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Literature review current through: 2017-07 . | This topic last updated: 2017-05-03.
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References
Top
  1. Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am 2006; 53:215.
  2. 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.
  3. 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.
  4. Sato S, Kuratomi Y, Inokuchi A. Pathological characteristics of the epiglottis relevant to acute epiglottitis. Auris Nasus Larynx 2012; 39:507.
  5. Glynn F, Fenton JE. Diagnosis and management of supraglottitis (epiglottitis). Curr Infect Dis Rep 2008; 10:200.
  6. Stroud RH, Friedman NR. An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. Am J Otolaryngol 2001; 22:268.
  7. Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenzae type B vaccine era: changing trends. Laryngoscope 2004; 114:557.
  8. Tanner K, Fitzsimmons G, Carrol ED, et al. Haemophilus influenzae type b epiglottitis as a cause of acute upper airways obstruction in children. BMJ 2002; 325:1099.
  9. Devlin B, Golchin K, Adair R. Paediatric airway emergencies in Northern Ireland, 1990-2003. J Laryngol Otol 2007; 121:659.
  10. González Valdepeña H, Wald ER, Rose E, et al. Epiglottitis and Haemophilus influenzae immunization: the Pittsburgh experience--a five-year review. Pediatrics 1995; 96:424.
  11. Solomon P, Weisbrod M, Irish JC, Gullane PJ. Adult epiglottitis: the Toronto Hospital experience. J Otolaryngol 1998; 27:332.
  12. Somenek M, Le M, Walner DL. Membranous laryngitis in a child. Int J Pediatr Otorhinolaryngol 2010; 74:704.
  13. Sivakumar S, Latifi SQ. Varicella with stridor: think group A streptococcal epiglottitis. J Paediatr Child Health 2008; 44:149.
  14. Mayo-Smith MF, Spinale JW, Donskey CJ, et al. Acute epiglottitis. An 18-year experience in Rhode Island. Chest 1995; 108:1640.
  15. Frantz TD, Rasgon BM, Quesenberry CP Jr. Acute epiglottitis in adults. Analysis of 129 cases. JAMA 1994; 272:1358.
  16. 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.
  17. 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.
  18. Lacroix J, Gauthier M, Lapointe N, et al. Pseudomonas aeruginosa supraglottitis in a six-month-old child with severe combined immunodeficiency syndrome. Pediatr Infect Dis J 1988; 7:739.
  19. Walsh TJ, Gray WC. Candida epiglottitis in immunocompromised patients. Chest 1987; 91:482.
  20. Myer CM 3rd. Candida epiglottitis: clinical implications. Am J Otolaryngol 1997; 18:428.
  21. Abou Zahr A, Saad Aldin E, Yunyongying P. Histoplasma epiglottitis in a patient with Crohn's disease maintained on infliximab, prednisone, and azathioprine. Int J Infect Dis 2013; 17:e650.
  22. Harjacek M, Kornberg AE, Yates EW, Montgomery P. Thermal epiglottitis after swallowing hot tea. Pediatr Emerg Care 1992; 8:342.
  23. Kulick RM, Selbst SM, Baker MD, Woodward GA. Thermal epiglottitis after swallowing hot beverages. Pediatrics 1988; 81:441.
  24. Lai SH, Wong KS, Liao SL, Chou YH. Non-infectious epiglottitis in children: two cases report. Int J Pediatr Otorhinolaryngol 2000; 55:57.
  25. Kavanagh KR, Batti JS. Traumatic epiglottitis after foreign body ingestion. Int J Pediatr Otorhinolaryngol 2008; 72:901.
  26. Mayo-Smith MF, Spinale J. Thermal epiglottitis in adults: a new complication of illicit drug use. J Emerg Med 1997; 15:483.
  27. Rosbe KW, Perez-Atayde AR, Roberson DW, Kenna M. Pathology forum: quiz case 1. Diagnosis: posttransplant lymphoproliferative disease (PTLD) of the epiglottis. Arch Otolaryngol Head Neck Surg 2000; 126:1153; discussion 1157.
  28. de Diego JI, Prim MP, Hardisson D, et al. Graft-vs-host disease as a cause of enlargement of the epiglottis in an immunocompromised child. Arch Otolaryngol Head Neck Surg 2001; 127:439.
  29. Centers for Disease Control and Prevention (CDC). Progress toward elimination of Haemophilus influenzae type b invasive disease among infants and children--United States, 1998-2000. MMWR Morb Mortal Wkly Rep 2002; 51:234.
  30. Garpenholt O, Hugosson S, Fredlund H, et al. Epiglottitis in Sweden before and after introduction of vaccination against Haemophilus influenzae type b. Pediatr Infect Dis J 1999; 18:490.
  31. Garner D, Weston V. Effectiveness of vaccination for Haemophilus influenzae type b. Lancet 2003; 361:395.
  32. Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol 2008; 122:818.
  33. McVernon J, Slack MP, Ramsay ME. Changes in the epidemiology of epiglottitis following introduction of Haemophilus influenzae type b (Hib) conjugate vaccines in England: a comparison of two data sources. Epidemiol Infect 2006; 134:570.
  34. Senior BA, Radkowski D, MacArthur C, et al. Changing patterns in pediatric supraglottitis: a multi-institutional review, 1980 to 1992. Laryngoscope 1994; 104:1314.
  35. Wood N, Menzies R, McIntyre P. Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease. Intern Med J 2005; 35:530.
  36. Nakamura H, Tanaka H, Matsuda A, et al. Acute epiglottitis: a review of 80 patients. J Laryngol Otol 2001; 115:31.
  37. Gorelick MH, Baker MD. Epiglottitis in children, 1979 through 1992. Effects of Haemophilus influenzae type b immunization. Arch Pediatr Adolesc Med 1994; 148:47.
  38. Briem B, Thorvardsson O, Petersen H. Acute epiglottitis in Iceland 1983-2005. Auris Nasus Larynx 2009; 36:46.
  39. Faden H. The dramatic change in the epidemiology of pediatric epiglottitis. Pediatr Emerg Care 2006; 22:443.
  40. Shah RK, Nussenbaum B, Kienstra M, et al. Wrong-site sinus surgery in otolaryngology. Otolaryngol Head Neck Surg 2010; 143:37.
  41. Annual Estimates of the Population by Five-Year Age Groups and Sex for the United States: April 1, 2000 to July 1, 2006 (NC-EST2006-01). http://www.census.gov/popest/national/asrh/NC-EST2006-sa.html (Accessed on April 22, 2011).
  42. Lee AC, Lam SY. Life threatening acute epiglottitis in acute leukemia. Leuk Lymphoma 2002; 43:665.
  43. Cocks HC, Johnson IJ. Acute epiglottitis: a presentation of haemophagocytic lymphohistiocytosis. J Laryngol Otol 2001; 115:819.
  44. Murray JC, Chiu JK, Dorfman SR, Ogden AK. Epiglottitis following preparation for allogeneic bone marrow transplantation. Bone Marrow Transplant 1995; 15:997.
  45. Charuvanij S, Houghton KM. Acute epiglottitis as the initial presentation of pediatric Systemic Lupus Erythematosus. Pediatr Rheumatol Online J 2009; 7:19.
  46. Ambrosino DM, Schiffman G, Gotschlich EC, et al. Correlation between G2m(n) immunoglobulin allotype and human antibody response and susceptibility to polysaccharide encapsulated bacteria. J Clin Invest 1985; 75:1935.
  47. Granoff DM, Pandey JP, Boies E, et al. Response to immunization with Haemophilus influenzae type b polysaccharide-pertussis vaccine and risk of Haemophilus meningitis in children with the Km(1) immunoglobulin allotype. J Clin Invest 1984; 74:1708.
  48. Tejani A, Mahadevan R, Dobias B, et al. Occurrence of HLA types in H. influenzae type B disease. Tissue Antigens 1981; 17:205.
  49. Whisnant JK, Rogentine GN, Gralnick MA, et al. Host factors and antibody response Haemophilus influenza type b meningitis and epiglottitis. J Infect Dis 1976; 133:448.
  50. 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.
  51. Chang YL, Lo SH, Wang PC, Shu YH. Adult acute epiglottitis: experiences in a Taiwanese setting. Otolaryngol Head Neck Surg 2005; 132:689.
  52. Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope 1990; 100:183.
  53. Park KW, Darvish A, Lowenstein E. Airway management for adult patients with acute epiglottitis: a 12-year experience at an academic medical center (1984-1995). Anesthesiology 1998; 88:254.
  54. BERENBERG W, KEVY S. Acute epiglottitis in childhood; a serious emergency, readily recognized at the bedside. N Engl J Med 1958; 258:870.
  55. Losek JD, Dewitz-Zink BA, Melzer-Lange M, Havens PL. Epiglottitis: comparison of signs and symptoms in children less than 2 years old and older. Ann Emerg Med 1990; 19:55.
  56. RABE EF. Infectious croup; Hemophilus influenzae type B croup. Pediatrics 1948; 2:559.
  57. Johnson GK, Sullivan JL, Bishop LA. Acute epiglottitis. Review of 55 cases and suggested protocol. Arch Otolaryngol 1974; 100:333.
  58. Battaglia JD, Lockhart CH. Management of acute epiglottitis by nasotracheal intubation. Am J Dis Child 1975; 129:334.
  59. Tibballs J, Watson T. Symptoms and signs differentiating croup and epiglottitis. J Paediatr Child Health 2011; 47:77.
  60. Hébert PC, Ducic Y, Boisvert D, Lamothe A. Adult epiglottitis in a Canadian setting. Laryngoscope 1998; 108:64.
  61. Oropharyngeal examination for suspected epiglottitis. Am J Dis Child 1988; 142:1261.
  62. Damm M, Eckel HE, Jungehülsing M, Roth B. Management of acute inflammatory childhood stridor. Otolaryngol Head Neck Surg 1999; 121:633.
  63. Damm M, Eckel HE, Jungehülsing M, Roth B. Airway endoscopy in the interdisciplinary management of acute epiglottitis. Int J Pediatr Otorhinolaryngol 1996; 38:41.
  64. Vauthy PA, Reddy R. Acute upper airway obstruction in infants and children. Evaluation by the fiberoptic bronchoscope. Ann Otol Rhinol Laryngol 1980; 89:417.
  65. Sobol SE, Zapata S. Epiglottitis and croup. Otolaryngol Clin North Am 2008; 41:551.
  66. Carey MJ. Epiglottitis in adults. Am J Emerg Med 1996; 14:421.
  67. Ehara H. Tenderness over the hyoid bone can indicate epiglottitis in adults. J Am Board Fam Med 2006; 19:517.
  68. Madhotra D, Fenton JE, Makura ZG, et al. Airway intervention in adult supraglottitis. Ir J Med Sci 2004; 173:197.
  69. Molteni RA. Epiglottitis: incidence of extraepiglottic infection: report of 72 cases and review of the literature. Pediatrics 1976; 58:526.
  70. Ragosta KG, Orr R, Detweiler MJ. Revisiting epiglottitis: a protocol--the value of lateral neck radiographs. J Am Osteopath Assoc 1997; 97:227.
  71. Ducic Y, Hébert PC, MacLachlan L, et al. Description and evaluation of the vallecula sign: a new radiologic sign in the diagnosis of adult epiglottitis. Ann Emerg Med 1997; 30:1.
  72. Schumaker HM, Doris PE, Birnbaum G. Radiographic parameters in adult epiglottitis. Ann Emerg Med 1984; 13:588.
  73. Hung TY, Li S, Chen PS, et al. Bedside ultrasonography as a safe and effective tool to diagnose acute epiglottitis. Am J Emerg Med 2011; 29:359.e1.
  74. Werner SL, Jones RA, Emerman CL. Sonographic assessment of the epiglottis. Acad Emerg Med 2004; 11:1358.
  75. Ko DR, Chung YE, Park I, et al. Use of bedside sonography for diagnosing acute epiglottitis in the emergency department: a preliminary study. J Ultrasound Med 2012; 31:19.
  76. 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.
  77. Stankiewicz JA, Bowes AK. Croup and epiglottitis: a radiologic study. Laryngoscope 1985; 95:1159.
  78. Hafidh MA, Sheahan P, Keogh I, Walsh RM. Acute epiglottitis in adults: a recent experience with 10 cases. J Laryngol Otol 2006; 120:310.
  79. Chan KO, Pang YT, Tan KK. Acute epiglottitis in the tropics: is it an adult disease? J Laryngol Otol 2001; 115:715.
  80. McEwan J, Giridharan W, Clarke RW, Shears P. Paediatric acute epiglottitis: not a disappearing entity. Int J Pediatr Otorhinolaryngol 2003; 67:317.
  81. Lee SS, Schwartz RH, Bahadori RS. Retropharyngeal abscess: epiglottitis of the new millennium. J Pediatr 2001; 138:435.
  82. Cherry JD. Clinical practice. Croup. N Engl J Med 2008; 358:384.
  83. Bjornson CL, Johnson DW. Croup. Lancet 2008; 371:329.
  84. Yen K, Flanary V, Estel C, et al. Traumatic epiglottitis. Pediatr Emerg Care 2003; 19:27.
  85. Kabbani M, Goodwin SR. Traumatic epiglottis following blind finger sweep to remove a pharyngeal foreign body. Clin Pediatr (Phila) 1995; 34:495.
  86. Li SF, Siegel B, Hidalgo I, et al. Laryngopyocoele: an unusual cause of a sore throat. Am J Emerg Med 2012; 30:1655.e1.
  87. Berger G, Landau T, Berger S, et al. The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Otolaryngol 2003; 24:374.
  88. Stack BC Jr, Ridley MB. Epiglottic abscess. Head Neck 1995; 17:263.
  89. Reed J, Shah RK, Jantausch B, Choi SS. Aryepiglottic abscess manifesting as epiglottitis. Arch Otolaryngol Head Neck Surg 2009; 135:953.
  90. Cable BB, Biega T. Radiology forum. Quiz case 1. Adult epiglottitis with epiglottic abscess. Arch Otolaryngol Head Neck Surg 2001; 127:212, 214.
  91. Schuh S, Huang A, Fallis JC. Atypical epiglottitis. Ann Emerg Med 1988; 17:168.
  92. 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.
  93. Kong MS, Engel SH, Zalzal GH, Preciado D. Necrotizing epiglottitis and hemophagocytic lymphohistiocytosis. Int J Pediatr Otorhinolaryngol 2009; 73:119.
  94. 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.