Evaluation of patients with adult acute epiglottitis

Yıl 2007, Cilt: 17 Sayı: 3, 152 - 157, 23.05.2007

Adin Selçuk Hüseyin Dere Işıl Taylan Mehmet Ali Çetin Serdar Ensari

Öz

Objectives: We evaluated adult patients who were treated for acute epiglottitis.Patients and Methods: The study included five adult patients who were diagnosed as having acute epiglot­ titis during an eight-month period. AH the patients were males with an age range of 38 to 54 years, except for a 77-year-old patient. The Friedman staging system was used to evaluate the severity of dyspnea and symptoms. Treatment was comprised of parenteral steroids and antibiotic therapy. The mean follow-up was one year range 11 to 17 months .Results: The main presenting symptom was moderate to severe dyspnea in ali the patients, which was rated as stage 4 in one patient, stage 3 in two patients, and stage 2 in two patients. Diagnoses were made by laryn- goscopic examination and lateral radiograms of the neck, which showed the thumb sign in ali the patients.Computed tomography of the neck revealed an epiglot- tic abscess in one patient. One patient required tra- cheotomy. AH the patients benefited from parenteral steroid and antibiotic treatment, with relief of dyspnea and difficulty in swallowing. The mean hospitalization was 5-6 days range 3 to 8 days . No recurrences were observed during the follow-up period.Conclusion: Acute epiglottitis in adult patients requires a timely and correct diagnosis and prompt appropriate treatment. A tracheotomy should not be avoided when necessary.

Anahtar Kelimeler

Adult, airway obstruction/etiology, epiglottitis/drug therapy

Akut epiglottitli erişkin olguların değerlendirilmesi

Öz

Amaç: Akut epiglottit nedeniyle tedavi edilen erişkinolgular değerlendirildi.Hastalar ve Yöntemler: Çalışmaya sekiz aylık birdönem içinde kliniğimizde akut epiglottit saptananbeş erişkin hasta sunuldu. Hastaların tümü erkektive 77 yaşında bir hasta dışında, yaşları 38-54 arasında değişmekteydi. Hastaların başvuru anındakisolunum sıkıntısı ve semptomların derecesi Friedman sınıflamasına göre değerlendirildi. Hastalaraparenteral steroid ve antibiyotik tedavisi uygulandı.Ortalama takip süresi bir yıl dağılım 11-17 ay idi.Bulgular: Tüm hastalarda asıl başvuru yakınmasısolunum sıkıntısıydı. Solunum sıkıntısının derecesibir hastada Friedman evre 4, iki hastada 3, iki hastada 2 idi. Tanı, larenks muayenesi ve boyun yan filmi ile kondu. Boyun radyografisinde tüm hastalardakalınlaşmış epiglot, “başparmak belirtisi” izlendi. Boyun ve larenks bilgisayarlı tomografisinde bir olgudaepiglot apsesi görüldü. Bir hastada trakeotomi gerekti. Parenteral steroid ve antibiyotik tedavisi sonucunda tüm olgularda solunum sıkıntısı geçti ve yutma güçlüğü düzeldi. Hastanede kalış süresi ortalama 5-6 gün dağılım 3-8 gün idi. Takip sırasındahiçbir hastada nüks görülmedi.Sonuç: Akut epiglottitli erişkin hastalarda doğru tanızamanında konmalı, zaman kaybetmeden uygun tedaviye başlanmalı ve gerektiğinde trakeotomidenkaçınılmamalıdır

Anahtar Kelimeler

Erişkin, havayolu tıkanıklığı/etyoloji, epiglottit/ilaç tedavisi

Kaynakça

• Nakamura H, Tanaka H, Matsuda A, Fukushima E, Hasegawa M. Acute epiglottitis: a review of 80 patients. J Laryngol Otol 2001;115:31-4.
• Wong EY, Berkowitz RG. Acute epiglottitis in adults: the Royal Melbourne Hospital experience. ANZ J Surg 2001;71:740-3.
• Rizk SS, Kacker A, Komisar A. Need for tracheotomy is rare in patients with acute supraglottitis: findings of a retrospective study. Ear Nose Throat J 2000;79:952-7.
• Stanley RE, Liang TS. Acute epiglottitis in adults (the Singapore experience). J Laryngol Otol 1988;102:1017-21.
• Chan KO, Pang YT, Tan KK. Acute epiglottitis in the tropics: is it an adult disease? J Laryngol Otol 2001; 115:715-8.
• Yanagisawa E. Inflammatory disease of the larynx. In: Lee KJ, editor. Essential otolaryngology, head and neck surgery. 6th ed. New York: McGraw Hill; 2004. p. 770-2.
• Ceyhan M. Hemofilus influenza tip B aşısı. Katkı Pediatri Dergisi 1998;19;195-204.
• Deeb ZE, Yenson AC, DeFries HO. Acute epiglottitis in the adult. Laryngoscope 1985;95:289-91.
• Frantz TD, Rasgon BM, Quesenberry CP Jr. Acute epiglottitis in adults. Analysis of 129 cases. JAMA 1994; 272:1358-60.
• Khilanani U, Khatib R. Acute epiglottitis in adults. Am J Med Sci 1984;287:65-70.
• Mayo-Smith MF, Hirsch PJ, Wodzinski SF, Schiffman FJ. Acute epiglottitis in adults. An eight-year experi- ence in the state of Rhode Island. N Engl J Med 1986; 314:1133-9.
• Kass EG, McFadden EA, Jacobson S, Toohill RJ. Acute epiglottitis in the adult: experience with a seasonal presentation. Laryngoscope 1993;103:841-4.
• D’Angelo AJ Jr, Zwillenberg S, Olekszyk JP, Marlowe FI, Mobini J. Adult supraglottitis due to herpes sim- plex virus. J Otolaryngol 1990;19:179-81.
• Dort JC, Frohlich AM, Tate RB. Acute epiglottitis in adults: diagnosis and treatment in 43 patients. J Otolaryngol 1994;23:281-5.
• Carenfelt C, Sobin A. Acute infectious epiglottitis in children and adults: annual incidence and mortality. Clin Otolaryngol Allied Sci 1989;14:489-93.
• Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest 1993;104:964-5.
• Jayaraman G, Ramshesh P, Padmanabhan K, Zaman MM. Pneumococcal bacteremia with retropharyngeal soft-tissue inflammation and acute epiglottitis. Ear Nose Throat J 2003;82:728-30.
• Gagnon R, Bedard PM, Cote L, Lavoie A, Hebert J. Recurrent acute epiglottitis in adults: defective anti- body response. Ann Allergy Asthma Immunol 2002; 88:513-7.