2013 Volume 64 Issue 3 Pages 175-181
Acute epiglottitis sometimes causes sudden upper airway obstruction, so it is very important to manage the airway. We retrospectively reviewed the clinical findings of 91 patients with acute epiglottitis who were hospitalized and received treatment between 2001 and 2011. There were 55 men and 36 women and their ages ranged from 16 to 82 years old (median 47). Among the 91 cases we performed airway management (tracheostomy/intubation) to preserve the airway in 9 cases. We divided the 91 cases into two groups, tracheostomy/intubation and conservative therapy, in order to investigate the characteristics of each group. In the tracheostomy/intubation groups, most patients complained of dysphagia and dyspnea at the first examination. WBC count and CRP showed no significant differences between the groups. Mean duration from symptom onset to first examination was 1.6 days in the tracheostomy/intubation group and 2.4 days in the conservative therapy group. We divided the patients into three groups by laryngeal findings according to the classification of Katori et al. All patients who required airway management (tracheostomy/intubation) belonged to Stage IIIB, which shows serious edema and swelling not only of the epiglottis but also of the arytenoid region. Tracheostomy was performed in 8 cases, including 6 under local anesthesia. Inevitably, laryngeal findings are the most important factor for determining the indication of tracheostomy. However, symptoms and patient history are also helpful for determining airway management.
