Samantha M Baird1, Philip A Marsh2, Alex Padiglione3, Jason Trubiano4, Bernard Lyons5, Andrew Hays6, Matthew C Campbell1, Damien Phillips1,7. 1. Department of Ear Nose and Throat/Head and Neck Surgery, Austin Health, Melbourne, Victoria, Australia. 2. Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia. 3. Infectious Diseases Department, Monash Health, Melbourne, Victoria, Australia. 4. Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia. 5. Department of Otolaryngology, Head and Neck and Skull Base Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia. 6. Ear Nose and Throat Unit, Monash Health, Melbourne, Victoria, Australia. 7. Department of Otolaryngology, Royal Children's Hospital, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia. METHODS: Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed. RESULTS: Eighty-seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention (P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type-b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury. CONCLUSION: Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection.
BACKGROUND: This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia. METHODS: Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed. RESULTS: Eighty-seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention (P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type-b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury. CONCLUSION: Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection.
Authors: Anna Penella; Marta Mesalles-Ruiz; Alejandro Portillo; Gabriel Huguet Llull; Eva Bagudà; Marta Capelleras; Julio Nogués; Manuel Mañós; Xavier Gonzàlez-Compta Journal: Eur Arch Otorhinolaryngol Date: 2022-04-09 Impact factor: 2.503