Adult epiglottitis: is there a consensus on diagnosis and treatment?

Adult epiglottitis is a different disease from that seen in paediatric patients both in the clinical picture and management. This paper presents 6 cases of adult epiglottitis which resulted in 2 deaths despite 3 patients having airway intervention. After reviewing some of the larger published series of adult epiglottitis in an attempt to find a consensus on management, a number of recommendations can be made: (1) indirect laryngoscopy is an essential diagnostic step which is safe in the adult and is more reliable than a lateral neck radiograph; (2) bacteriology specimens play no part in acute management and antibiotics must be given empirically; (3) adrenaline may be of value in avoiding airway intervention; (4) airway intervention must be a clinical decision and the conditions for its successful outcome made as favourable as possible by realizing that all patients can rapidly develop life threatening respiratory obstruction. An 'intensive care' level of clinical monitoring and early involvement of experienced ENT and anaesthetic staff is recommended.