Endoscopy should not be performed if there is concern of impending airway obstruction. Physical examination with laryngoscopy is extremely useful in differentiating these diagnoses. They may show signs of “air hunger” or may have stridor.ĭifferential diagnosis includes tonsillitis, peritonsillar abscess, retropharyngeal abscess, airway foreign body, and croup. Classically, these patients are in a sitting position leaning forward, because this position tends to alleviate obstructive symptoms from the supraglottic swelling. Many patients have difficulty with their saliva and drool. A “supraglottic,” muffled voice is common. Signs and symptoms of epiglottitis include rapidly developing sore throat, high fever, restlessness, and lethargy. Mortality rates of 6% to 7% have been reported in adults. ![]() Epiglottitis occurs mainly in children age 2 to 7 years, although infants, older children, and adults can be affected. Croup, tonsillitis, peritonsillar abscess, and other neck infection may be incorrectly diagnosed in these patients. The physician should always be suspicious when a patient presents with fever, sore throat, and difficulty swallowing, and when the severity of oropharyngeal physical findings is not in proportion to the symptoms. Rapid decompensation and complete loss of the airway are the sequelae of most concern. ![]() A high level of suspicion is necessary to make a diagnosis and avoid significant morbidity. Epiglottitis results from bacterial (and rarely viral) infection of the supraglottic structures, that is, the epiglottis and arytenoid cartilages. Epiglottitis (or “supraglottitis”) is a condition that requires prompt attention by the physician.
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