Epiglottic abscess

Clinical and Microbiological Factors Associated With Abscess Formation in Adult Acute Epiglottitis

OBJECTIVES

To evaluate clinical and microbiological findings that are correlated with abscess formation in adult acute epiglottitis (AE).

METHODS

We reviewed 140 cases of adult AE. Demographic, clinical, imaging, and microbiological findings are analyzed for all patients with AE in comparison to those with epiglottic abscess (EA).

RESULTS

A total of 113 patients presented with AE and 27 presented or progressed to EA (19.3%). Age, sex, seasonality, smoking, body mass index (BMI), and comorbidities were statistically insignificant between the 2 groups. Muffled voice (P < .013), respiratory distress (P < .001), and pre-existence of epiglottic cyst (P < .001) are symptoms and signs connected with abscess formation. A total of 120 patients were treated conservatively. Surgical treatment was performed on 20 patients with EA. About 72 out of 80 cultures revealed monomicrobial infection. Mixed flora was isolated in 8 patients with EA. Streptococcus was isolated in 51 out of 80 positive cultures (64%). Haemophilus Influenza (Hib) was not isolated in any sample. EA and mixed flora relates to a higher rate of airway intervention (P < .001).

CONCLUSION

A high level of suspicion for abscess formation is required if clinical examination reveals dyspnea, muffled voice, or an epiglottic cyst in adult with AE. The existence of EA doubles the duration of hospitalization. EA is typically found on the lingual surface of the epiglottis. Supraglottic or deep neck space expansion should be treated surgically. EA is associated with a mixed flora and a higher rate of airway obstruction. Streptococcus is discovered to be the most common pathogen.

Use of Indirect Laryngeal Biopsy Forceps to Treat Epiglottic Abscess

OBJECTIVES

To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA).

METHODS

Twenty patients were diagnosed with EA in our department and were randomly divided into group A (indirect laryngeal biopsy forceps combined antibiotics) and group B (antibiotics only). Demographics, the degree of epiglottic and arytenoid swelling, and inflammatory cells were collected for analysis. The drainage of EA was performed under local anesthesia in conscious patients with indirect laryngeal biopsy forceps and 70° direct laryngoscopes. The length of symptomatic relief and length of hospitalization were assessed.

RESULTS

Ten patients were treated with indirect laryngeal biopsy forceps under the view of the 70° direct laryngoscopes combined with intravenous antibiotics, whereas the other 10 patients were treated with antibiotics only. The differences between the 2 groups had no statistical significance in age, gender, white blood cell count, neutrophils count, and the percent of neutrophils, abscess size, and scope classification at the time of diagnosis. The length of hospitalization and length of symptomatic relief was significantly lower in patients treated with indirect laryngeal biopsy forceps combined antibiotics than those treated with antibiotics only.

CONCLUSIONS

Indirect laryngeal biopsy forceps are safe and effective method to treat EA, which shorten the hospitalization and has the advantages of cost savings and convenience.

Airway Management for an Adult Epiglottic Abscess

Awake intubation is frequently described in the literature as the preferred method for securing the airway in adult patients with epiglottitis, whereas children with epiglottitis are usually intubated following an inhalational induction. However, if topicalization is difficult due to the presence of an abscess or an uncooperative patient, an inhalational induction may still be a reasonable approach in the adult patient. In a review of the literature, only one recent case report had been found describing an inhalational induction with video laryngoscopy. However, this attempt was unsuccessful, mandating the need for a surgical airway. Our case report describes a successful inhalational induction and video laryngoscope intubation without the use of a paralytic agent in an adult patient with an epiglottic abscess and moderate airway stenosis.

Airway Obstruction Secondary to Emphysematous Epiglottitis: A Case Report

BACKGROUND Despite a shift in the epidemiology of epiglottitis following the introduction of the Haemophilus influenzae type B vaccine, acute infectious epiglottitis continues to be a relatively common and potentially life-threatening infection in adults. Epiglottitis complicated by abscess is rare, and emphysematous abscess is even less common. Early diagnosis and intervention is paramount in reducing morbidity and mortality. Although case reports exist, photographic depiction of this complication is not readily available. CASE REPORT We present the case of a 59-year-old male with rapidly progressive emphysematous epiglottitis managed with awake fiber optic intubation followed by incision, drainage, and antibiotic therapy. Early recognition and intervention in this patient led to complete resolution of the infection, with no long-term sequelae. CONCLUSIONS Clinicians should be familiar with the radiographic and endoscopic findings which support an emphysematous abscess, as well as the treatment and airway management concerns in such cases.