Otolaryngology
was consulted and flexible fiberoptic laryngoscoscopy
was performed. Diagnosis of supraglottic edema (acute
epiglottitis) of unknown etiology: possibly angioedema
from increasing tumor or infection. He did not improve
on dexamethasone and was taken to the Operating Room for
tracheotomy in the morning.
DISCUSSION
Impending
complete airway obstruction from supraglottic edema is
a medical emergency. Epiglottitis is more common among
children than adults but since the advent of Haemophilus
influenza type B vaccine in 1985, the incidence has
decreased from 100 cases per 100,000 to 0.3 per 100,000.
Typical symptoms include fever, irritability, dysphonia,
and dysphagia in someone sitting forward and drooling.
Treatment should focus on airway management and appropriate
antimicrobial agents. Lateral neck films could show an
enlarged epiglottis ("thumb sign"). Although we got the
films, it is not typically recommended since it will delay
in securing the airway. Direct laryngoscopy is not recommended
because of the possibility of laryngospasm. Fiberoptic
visualization is recommended with preparations to maintain
an airway via intubation or tracheotomy. Patients should
be closely monitored in an intensive care unit and treatment
against H. influenza should be initiated. In adults, blood
cultures are positive in only 25% of the cases. Treatment
options include: cefuroxime, ampicillin/sulbactam, or
nafcillin plus ceftriaxone.
REFERENCES
