The Laryngoscope C 2011 The American Laryngological, V

Rhinological and Otological Society, Inc.

Acute Supraglottitis in Adults in Finland: Review and Analysis of 308 Cases Argyro J. Bizaki, MD; Jura Numminen, MD; Jussi-Pekka Vasama, MD; Jussi Laranne, MD; Markus Rautiainen, MD Objective: The aim of this article is to study the clinical features, management, and outcome in adult patients with acute supraglottitis. Study Design: Retrospective review. Methods: We searched the medical records from our database from the years 1989 to 2009 using codes of international statistical classification of diseases and related health problems for acute epiglottitis or supraglottitis. In total, 308 patients were identified. Results: Incidence of acute supraglottitis increased from 1.88 (first decade) to 4.73 per 100,000 cases (second decade) (P ¼ .05). The mean age of the patients was 49 years old with a slightly male predominance. Sore throat and odynophagia were the most common symptoms. Concomitant disease were common among the patients. Isolated inflammation of epiglottis without involvement of other supraglottic tissue was detected only in 51 patients. Intravenous cephalosporins were the most common empiric antibiotic treatment regimen. Intravenous corticosteroids were administered to half of the cases. Streptococcus was the most common organism in throat cultures. In total, 45 patients needed airway intervention. Complications were rare and mortality was 0.6% in our series. Conclusions: Acute supraglottitis in adults seems to be a different entity than epiglottitis in children, and inflammation does not usually exclusively involve the epiglottis. Early diagnosis seems to decrease the need for airway intervention and to permit the successful treatment of the patient with intravenous antibiotics and corticosteroids. Streptococcus appears as the dominant causative microorganism. However systemic diseases and other local infections that compromise the regional supraglottic immunity may increase the risk for acute supraglottitis. Key Words: Supraglottitis, epiglottitis, stridor, dyspnea, sore throat, airway intervention. Level of evidence: 2c (longitudinal multivariable epidemiologic study). Laryngoscope, 121:2107–2113, 2011

INTRODUCTION Acute epiglottitis, more appropriately referred to as supraglottitis, is the acute inflammation of the supraglottic region of the epiglottis, vallecula, arytenoids, and aryepiglottic folds. It is a severe inflammation in the upper respiratory tract, and due to the loose mucosa and its rich vascularity, the epiglottic region involves a high risk of sudden airway obstruction and possible death. The diagnosis of acute epiglottitis is established by the direct or indirect visualisation of the inflamed epiglottis and supraglottic area during laryngoscopic examination. Before the introduction of the Haemophilus influenzae type b (Hib) vaccination, acute epiglottitis was more common in children, and in the majority of cases the causative microorganism was Hib. Since the introducFrom the Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampere, Finland. Editor’s Note: This Manuscript was accepted for publication May 24, 2011. This study obtained the approval of hospital’s ethical committee. The authors have no financial disclosures for this article. The authors have no conflicts of interest to disclose. Send correspondence to Dr. Argyro J. Bizaki, Department of Otorhinolaryngology, Tampere University and Tampere University Hospital, Tampereen yliopistollinen sairaala, PL 2000, 33521 Tampere, Finland. E-mail: [email protected] DOI: 10.1002/lary.22147

Laryngoscope 121: October 2011

tion of the vaccination, acute epiglottitis is much less common in children. However, incidence of acute epiglottitis in adults has not decreased. Studying epiglottitis from a wide perspective would provide data for better understanding the process of this disease and for facilitating the creation of standardized and efficient treatment algorithms. It has been supported that adult acute epiglottitis might be a distinct form of the disease. With regard to children, the stereotypical patient is a previously healthy child that has an acute onset of the symptoms. However, in previous studies it has been noted that this does not apply to adult acute epiglottitis. It seems that a significant number of patients have underlying concomitant medical conditions at the time of diagnosis that have relatively weakened their immunity and made them more vulnerable.1,2 In this study carried out at the University Hospital of Tampere in Finland, we reviewed those medical records classified as epiglottitis or supraglottitis, (from the pre- and post-Hib vaccination period) regarding the clinical, aetiological, and epidemiological features of adult epiglottitis. The goals of this study were to identify the possible risk factors that predispose a patient to develop acute supraglottitis and to evaluate the consistency and efficiency of the treatment algorithm. Bizaki et al.: Acute Supraglottitis in Adults in Finland

2107

Symptoms and Signs

TABLE I. Differences between the Studied Decades.

Incidence (in 100,000)

1989–1999

2000–2009

P Value

1.88

4.73

.05

Hospitalization (in days) Intravenous corticosteroids

6.4 25.8%

5 71.2%