Acute epiglottitis causes sudden upper airway obstruction and may trigger death within hours. Intubation is difficult, often necessitating tracheostomy, due to epiglottal swelling. Although appropriate judgment is required for choosing tracheostomy or conservative management with steroids and antibiotics, no guideline yet exists for this disease.
We retrospectively examined 113 subjects hospitalized with acute epiglottitis, dividing then into two groups—tracheostomy and nontracheostomy. Comparing them for age, gender, common symptoms, clinical aspects, past history, and hospitalization duration, we clarified factors that may determine which is better—tracheostomy or conservative treatment.
Mean age of the subjects was 49 years (range, 11 to 88 years, mean: 49 years) and the male-to-female ratio was 2.2 to 1.0. The commonest symptoms were sore throat (97%), odynophagia (49%), and fever (44%). Tracheostomy was done 11 cases (10%), but most cases treated conservatively (90%). A 44-year-old man died of cardiopulumonary arrest, despite tracheostomy. All subjects recovered completely. Mean duration from symptom onset to the first medical examination was 0.6 days in the tracheostomy group and 1.9 days in the nontracheostomy group, statistically significant (p<0.01). Other independent factors were the chief complaint of respiratory distress and stridor, 71% and 16% in tracheostomy and 55% and 2% in nontracheostomy. A statistically significant difference was also seen in Katori's grading by endoscopic observation between groups (p<0.01). These four factors may thus be clinically useful in evaluating the necessity of airway intervention.