A Clinical Study of Patients with Acute Epiglottitis

Abstract

Acute epiglottitis is an acute inflammation of the upper respiratory airway that rarely causes airway obstruction. A retrospective study was conducted on 115 patients with acute epiglottitis from April 2007 to December 2017 (65 males and 50 females; aged 12–85 years old, median age of 45 years). When counting the number of patients according to the month, from April to September more than 10 patients were treated. Median duration from symptom onset to first visit was 3 days (1–14 days). Eight (7%) of 115 patients had diabetes, and 16 (13.9%) had epiglottic cyst. We divided all the patients into six groups by laryngeal findings according to the classification of Katori and Tsukuda. Number of patients classified as IA, IB, IIA, IIB, IIIA, and IIIB was 41 (35.7%), 21 (18.3%), 22 (19.1%), 15 (13%), 8 (7%), and 8 (7%), respectively. Median duration of hospitalization was 5 days (2–26 days). In the blood test on the first day of hospitalization, the number of white blood cells (WBC) ranged from 3,400 to 25,350/μL (median 10,350/μL) and the C-reactive protein (CRP) ranged from 0.01 to 23.3 mg/dL (median, 2.5 mg/dL). The number of WBC and CRP at the fourth day after the hospitalization was significantly lower than those at the first day. Eight (7%) patients required the airway management such as tracheotomy or cricothyroidotomy. Age, laryngeal finding (severe epiglottis swelling and arytenoid edema; Katori and Tsukuda's classification IIIB), and high inflammatory reaction in blood test (WBC ≥ 20,000/μL and CRP ≥ 20 mg/dL) were the factors that significantly correlated with the airway management.

Keywords

acute epiglottitis - airway management - laryngeal finding - inflammatory reaction in blood test - tracheotomy

Patient Consent

Informed consent for publication of clinical details was obtained from all patients.

• References

• 1 Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol 2005; 119 (12) 967-972
• 2 Tanaka S, Kikuchi S, Ohata A, Tsutsumi T, Ohki M. A clinical study of 285 cases of acute epiglottitis [in Japanese]. Nippon Jibiinkoka Gakkai Kaiho 2015; 118 (11) 1301-1308
• 3 Uwa N, Hatta C, Tsuji K. , et al. Clinical study of 29 cases of acute epiglottitis [in Japanese]. Pract Otorhinolaryngol 2003; 96 (09) 811-817
• 4 Kametani R, Manaka K, Matsunaga E. , et al. Clinical study of 93 cases of acute epiglottitis. J Japan Broncho Esophagol Soc 1998; 49: 436-441
• 5 Murata T, Muroi M, Furuya N. Acute epiglottitis: analysis of factors associated with tracheostomy. Pract Otorhinolaryngol 2010; 103: 833-838
• 6 Ishida E, Katori Y, Watanabe K. , et al. A clinical study of 71 cases of acute epiglottitis [in Japanese]. Nippon Jibiinkoka Gakkai Kaiho 2007; 110 (07) 513-519
• 7 Koizumi H, Ohbuchi T, Nagatani G. , et al. A clinical study of 64 cases of acute epiglottitis. Pract Otorhinolaryngol 2012; 105: 1079-1083
• 8 Kimura S, Tsubuku T, Matsumura M. , et al. A clinical study of 54 cases of acute epiglottitis. J Japan Soc Head Neck Surg 2015; 25: 351-356
• 9 Hasegawa K, Ichihara S, Nishikawa S. , et al. Clinical study of 91 cases of acute epiglottitis. J Japan Broncho Esophagol Soc 2013; 64: 175-181
• 10 Sugio Y, Kukita N, Fujitani S. , et al. Clinical analysis of acute epiglottitis. J Japan Soc Infect Dis Otolaryngol 2000; 18: 33-36
• 11 Takagi H, Horiguchi S. Treatment of acute epiglottitis: epidemiology of acute epiglottitis. ENTONI 2004; 08: 1-6
• 12 Yamagiwa M. Acute epiglottitis. Otolaryngology 1987; 59 (01) 59-63
• 13 Katori H, Tsukuda M, Taguchi T. , et al. Clinical investigation of acute epiglottitis. Otolaryngol Head Neck Surg 2004; 76: 721-724
• 14 Matsumoto S, Saiki T, Sakaki M. , et al. Clinical study of 122 cases of acute epiglottitis with hospital treatment. Pract Otorhinolaryngol 2009; 102: 857-864
• 15 Iida M, Hesaka H, Matsui M. , et al. Clinical investigation of 170 cases of acute epiglottitis. Otorhinolaryngology 1999; 42: 374-379
• 16 Taniyama T, Sugiyama T, Araki M. , et al. A study of 68 cases of acute epiglottitis. J Japan Broncho Esophagol Soc 2014; 65: 221-225
• 17 Suzuki S, Yasunaga H, Matsui H, Fushimi K, Yamasoba T. Factors associated with severe epiglottitis in adults: analysis of a Japanese inpatient database. Laryngoscope 2015; 125 (09) 2072-2078
• 18 Kikuchi M, Nishida Y. Treatment of acute epiglottis: Staging of acute epiglottitis. ENTONI 2004; 08: 20-24
• 19 Yoshifuku K, Ohhori J, Miyashita K. , et al. Usefulness of scarification for patients with adult acute epiglottitis. J Japan Soc Infect Dis Otolaryngol 2013; 31: 125-128
• 20 Miyazawa T, Murata H, Shimode Y. , et al. Timing for emergent airway preservention of acute epiglottitis in adults. J Japan Soc Infect Dis Otolaryngol 2008; 26: 125-129
• 21 Friedman M, Toriumi DM, Grybauskas V, Applebaum EL. A plea for uniformity in the staging and management of adult epiglottitis. Ear Nose Throat J 1988; 67 (12) 873-874 , 876–877, 880
• 22 Hashimoto D, Yao K, Nishiyama K. , et al. A clinical study of 237 cases of acute epiglottitis. J Japan Broncho Esophagol Soc 2004; 55: 245-252
• 23 Hayashi T. Acute epiglottitis: clinical judgment for airway intervention. Pract Otorhinolaryngol 2010; 103: 786-787