Acute Epiglottitis

Presenting complaints:

35 years old male patient presented with:

1. Fever - 1 week duration

2. Pain while swallowing (Odynophagia) - 4 days

3. Drooling of saliva - 4 days

4. Change in voice - 4 days

On examination:

Drooling of saliva ++

Hot potato voice ++

Indirect laryngoscopy: Showed swelling of epiglottis, aryepiglottic folds. Pooling of saliva was
seen in both pyriform fossa. Food material could also be seen accumulated in the pyriform fossa.
Both vocal cords were freely mobile

X-ray soft tissue neck lateral view:

X-ray soft tissue neck lateral view shows an enlarged epiglottis shaped like a thumb. This
feature is known as the "Thumb sign".

thumb.jpg

X-ray soft tissue neck lateral view showing "thumb sign"

Videolaryngoscopy:

Discussion:

This condition is also known as supraglottic laryngitis.

Supraglottic laryngitis:

Also known as acute epiglottitis. This is an inflammation involving the epiglottis. This condition is commonly seen in children. It is commonly caused by H. Influenza. In adults it can be caused by allergy, trauma to epiglottis due to foreign body, GERD etc.

Clinical features:

1. Excessive throat pain
2. Hot potato voice
3. Difficulty in swallowing
4. Difficulty in breathing is common in children. These patients may need tracheostomy.

Indirect laryngoscopic examination shows: Oedematous reddish epiglottis. The aryepiglottic folds may also appear edematous.

Treatment:

1. Rest
2. Voice rest
3. Antibiotics
4. Systemic steroids (Hydrocortisone in doses of 100 mg 6th hourly can be adminsitered)
5. Tracheostomy if there is respiratory distress

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