Excerpt from Epiglottitis, Adult


Synonyms, Key Words, and Related Terms: epiglottitis, inflammation of the epiglottis, sudden airway obstruction, Haemophilus influenzae B vaccine, H influenzae, Haemophilus influenzae type B, Hib vaccine, Hib vaccination

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Background: Epiglottitis is an acute inflammation in the supraglottic region of the oropharynx with inflammation of the epiglottis, vallecula, arytenoids, and aryepiglottic folds.

George Washington probably died of epiglottitis in 1799.

Pathophysiology: Epiglottitis is an acute inflammation involving the epiglottis, vallecula, aryepiglottic folds, and arytenoids.

Frequency:

  • In the US: Epiglottitis is an uncommon disease. Incidence in adults is about 1 case per 100,000 per year. Adult epiglottitis is most frequently a disease of men, occurring during the fifth decade of life. The ratio of incidence in children to adults was 2.6:1 in 1980 and dropped to 0.4:1 in 1993. Occurrence has decreased since introduction of the Haemophilus influenzae B vaccine. However, vaccine failures are possible.
  • Internationally: Epiglottitis is generally more common in nations that do not immunize against H influenzae type B. For example, in Sweden from 1987-1989, incidence was 14.7 per 100,000 people per year in children aged 0-4 years and 3.2 per 100,000 people per year overall. A large-scale Hib vaccination program in 1992-1993 resulted in a substantial decrease in Swedish cases of acute epiglottitis.

    A retrospective review from the tropical country of Singapore over 8 years, ending in 1999, demonstrated 32 cases of acute epiglottitis, only 1 of which occurred in a child. During this time, Hib immunization was not routine, so Hib immunization cannot be used to explain the increased adult epiglottitis prevalence found in this study.

Mortality/Morbidity:

  • Risk of death is high due to sudden airway obstruction and difficulty intubating patients with extensive swelling of supraglottic structures.
  • The adult mortality rate is around 7%.
  • Mortality rate in pediatric cases is less than 1%.

Sex:

  • The male-to-female ratio is approximately 3:1.

Age:

  • Average age among adults is approximately 45 years.
  • The condition is now more common in adults than in children in the United States.
  • In the pediatric population, epiglottitis is most common in those aged 3-7 years, although any age may be affected.Please click here to view the full topic text: Epiglottitis, Adult