Vol.102 No.10 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 102 No. 10 October 2009
Clinical Study of 122 Cases of Acute Epiglottitis with Hospital Treatment
Shuichi Matsumoto, Tadahiko Saiki, Masaru Sakaki and Futoshi Watanabe
(Nippon Steel Hirohata Hospital)
In a retrospective study of clinical acute epiglottitis findings, we reviewed cases of 122 subjects-85 men and 37 wemen from 17 to 90 years old (mean: 49.1)-hospitalized and treated between January 2003 and December 2008. Chief symptoms (individual cases had multiple symptoms) were sore throat in 121 (99.2％), dysphagia in 32 (26.2％), elevated fever in 30 (24.6％), and dyspnea in 17 (13.9％). Prior to hospitalization, 70.5％ of patients had been to otorhinolaryngological clinics and 27.0％ to internal medicine clinics. Laryngeal inspection using a flexible fiberscope was important for diagnosis. Based on epiglottis swelling, arytenoid and aryepiglottic fold, and the dyspnea grade, we divided patients into stage I, slight, stage II, moderate, and stage III, severe. Stage I epiglottitis cases number 61 (50.0％), stage II 43 (35.2％), and stage III 18 (14.8％). Time from symptom onset to hospital visit averaged 3.7 days in stages I and II and 2.6 days in stage III. Local complications were peritonsillitis or peritonsilar abscess in 9 (7.4％), whitish wound of the epiglottis in 9 (7.4％), and epiglottic cyst in 8 (6.6％). We administered antibiotics in 121 cases (99.2％), mainly flomoxef sodium (FMOX) and clindamycin (CLDM) and steroid in 110 cases (90.2％). Six stage III cases (4.9％) required emergency airway management, 5 tracheostomy, and 1 endotracheal intubation. Hospitalization was from 3 to 33 days, or an average of 6.9 days, specifically 6.0 days for stage I, 6.3 days for stage II, and 11.6 days for stage III. Recurrence was seen in 5 (4.1％) and prognosis was good with no deaths.
Clinicians should keep each other mutually informed about clinical features of acute epiglottitis, especially those involving severe sore throat and/or dysphagia without severe local pharyngeal findings.
Key words :acute epiglottitis, inspection using flexible fiberscope, emergency airway management