Diagnosis and management of supraglottitis (Epiglottitis)

  • Fergal Glynn
  • John E. FentonEmail author


Acute supraglottitis is a serious, potentially fatal infection in both adults and children. Haemophilus influenzae type b (Hib) is the most common cause in children, even in this era of the Hib vaccine. Most cases of acute supraglottitis in adults are thought to be caused by other bacterial organisms, viral or combined viral-bacterial infections, and noninfectious etiologies. Early visualization of the larynx is essential, as is establishment of a secure airway in selected cases. Most cases will respond to intravenous antibiotic therapy and will not require an artificial airway. Admission to an area of high-intensity nursing is essential. Daily laryngoscopy is necessary to monitor response to treatment. Although the incidence of acute supraglottitis in children has decreased, isolated cases will be encountered and demand high vigilance.


Conjugate Vaccine Herd Immunity Croup Moraxella Catarrhalis Epiglottitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References and Recommended Reading

  1. 1.
    Carey MJ: Epiglottitis in adults. Am J Emerg Med 1996, 14:421–424.PubMedCrossRefGoogle Scholar
  2. 2.
    Mayo-Smith MF, Spindale JW, Donskey CJ, et al.: Acute epiglottitis. An 18 year experience in Rhode Island. Chest 1995, 108:1640–1647.PubMedCrossRefGoogle Scholar
  3. 3.
    Midwinter KI, Hodgson D, Yardley M: Paediatric epiglottitis: the influence of the Haemophilus influenza type b vaccine, a ten year review in the Sheffield region. Clin Otolaryngol Allied Sci 1999, 24:447–448.PubMedCrossRefGoogle Scholar
  4. 4.
    McVernon J, Slack MP, Ramsay ME: Changes in the epidemiology of epiglottitis following the introduction of Haemophilus influenza type b conjugate vaccines in England: a comparison of two data sources. Epidemiol Infect 2006, 134:570–572.PubMedCrossRefGoogle Scholar
  5. 5.
    Faden H: The dramatic change in the epidemiology of paediatric epiglottitis. Pediatr Emerg Care 2006, 22:443–444.PubMedCrossRefGoogle Scholar
  6. 6.
    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, 104:1503–1506.PubMedCrossRefGoogle Scholar
  7. 7.
    Hebert PC, Ducic Y, Boisvert D, Lamothe A: Adult epiglottitis in a Canadian setting. Laryngoscope 1998, 108:64–69.PubMedCrossRefGoogle Scholar
  8. 8.
    Berger G, Landau T, Berger S, et al.: The rising incidence of adult acute epiglottitis and epiglottitis abscess. Am J Otolaryngol 2003, 24:374–383.PubMedCrossRefGoogle Scholar
  9. 9.
    Garner D, Weston V: effectiveness of vaccination for Haemophilus influenza type b. Lancet 2003, 361:395–396.PubMedCrossRefGoogle Scholar
  10. 10.
    Tanner K, Fitzsimmons G, Carrol ED, Clark JE: Haemophilus influenza type b epiglottitis as a cause of acute airway obstruction in children. BMJ 2002, 325:1099–1100.PubMedCrossRefGoogle Scholar
  11. 11.
    Shah RK, Robertson DW, Jones DT: Epiglottitis in the Hemophilus influenza type b vaccine era: changing trends. Laryngoscope 2004, 114:557–560.PubMedCrossRefGoogle Scholar
  12. 12.
    Guldfred LA, Lyhne D, Becker BC: Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol 2007, Sep 25:1–6 (Epub ahead of print).Google Scholar
  13. 13.
    Trollfors B, Nylen O, Strangert K: Acute epiglottitis in adults and children in Sweden 1981–1983. Arch Dis Child 1990, 65:491–494.PubMedGoogle Scholar
  14. 14.
    Madhotra D, Fenton JE, Makura ZG, et al.: Airway intervention in adult supraglottitis. Ir J Med Sci 2004, 173:197–199.PubMedGoogle Scholar
  15. 15.
    Senior BA, Radkowski D, McArthur C, et al.: Changing patterns in pediatric supraglottitis: a multi-institutional review, 1980–1992. Laryngoscope 1994, 104:1314–1322.PubMedCrossRefGoogle Scholar
  16. 16.
    Ward MA: Emergency department management of acute respiratory infections. Sem Respir Infect 2002, 17:65–71.CrossRefGoogle Scholar
  17. 17.
    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, 1157–1158.PubMedGoogle Scholar
  18. 18.
    Devlin B, Glochin K, Adair R: Paediatric airway emergencies in Northern Ireland, 1990–2003. J Laryngol Otol 2007, 121:659–663.PubMedCrossRefGoogle Scholar
  19. 19.
    Holmes SJ, Granoff DM: The biology of Haemophilus influenza type b vaccination failure. J Infect Dis 1992, 165:S121–S128.PubMedGoogle Scholar
  20. 20.
    Heath PT, Booy R, Azzopardi HJ, et al.: Antibody concentration and clinical protection after Hib conjugate vaccination in the United Kingdom. JAMA 2000, 284:2334–2340.PubMedCrossRefGoogle Scholar
  21. 21.
    McCaig LF, Hughes JM: Trends in antimicrobial drug prescribing among office based physicians in the United States. JAMA 1995, 273:214–219.PubMedCrossRefGoogle Scholar
  22. 22.
    Hafidh MA, Sheahan P, Keogh IJ, McConn Walsh R: Acute epiglottitis in adults: a recent experience with 10 cases. J Laryngol Otol 2006, 120:310–313.PubMedCrossRefGoogle Scholar
  23. 23.
    Gonzalez Valdepena H, Wald ER, Rose E, et al.: Epiglottitis and Haemophilus influenzae immunization: the Pittsburgh experience—a five year review. Paediatrics 1995, 96:424–427.Google Scholar
  24. 24.
    Rafei K, Lichenstein R: Airway infectious disease emergencies. Pediatr Clin North Am 2006, 53:215–242.PubMedCrossRefGoogle Scholar
  25. 25.
    Kilham H, Gillis J, Benjamin B: Severe upper airway obstruction. Pediatr Clin North Am 1987, 34:1–14.PubMedGoogle Scholar
  26. 26.
    Cantrell RW, Bell RA, Morioka WT: Acute epiglottitis: intubation versus tracheostomy. Laryngoscope 1978, 88:994–1005.PubMedCrossRefGoogle Scholar
  27. 27.
    Wolf M, Strauss B, Kronenberg J, Leventon G: Conservative management of adults epiglottitis. Laryngoscope 1990, 100:183–185.PubMedGoogle Scholar
  28. 28.
    Ames WA, Ward VM, Tranter RM, Street M: Adult epiglottitis: an underdiagnosed, life threatening condition. Br J Anaesth 2000, 85:795–797.PubMedCrossRefGoogle Scholar
  29. 29.
    Local ethical committees: council approves revised report. BMJ 1981, 282:1010.Google Scholar
  30. 30.
    Baxter FJ, Dunn GL: Acute epiglottitis in adults. Can J Anesth 1988, 35:4:428–435.PubMedCrossRefGoogle Scholar
  31. 31.
    Katori H, Tsukuda M: Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol 2005, 119:967–972.PubMedGoogle Scholar
  32. 32.
    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, 106:1072–1075.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Department of Otolaryngology Head and Neck SurgeryMid Western Regional HospitalDooradoyle, LimerickIreland

Personalised recommendations