RT Book, Section A1 Shah, Ashish A1 Sobolewski, Brad A1 Mittiga, Matthew R. A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181044554 T1 Epiglottitis (General Conditions) T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181044554 RD 2024/10/03 AB Epiglottitis (also known as supraglottitis) is a life-threatening condition characterized by sudden onset of fever, irritability, sore throat, moderate to severe respiratory distress with stridor, and variable degrees of drooling. It results from a cellulitis of the epiglottis, aryepiglottic folds, and adjacent tissues. The patient generally appears toxic and prefers a sitting position, leaning forward with the neck extended in a sniffing position with an open mouth. With the addition of the H influenzae type B vaccine to the routine immunization schedule, there has been a dramatic decrease in the incidence of epiglottitis as well as a shift in the bacterial etiology. Although H influenzae type B is still the most common cause, many cases are now caused by nontypeable H influenzae, streptococci, staphylococci (especially MRSA), and Candida albicans. Adults typically have a more indolent course characterized by severe sore throat and odynophagia. Direct thermal injury has been reported as a noninfectious cause. On soft-tissue lateral neck x-ray, the epiglottis is seen as rounded and blurred (thumbprint sign). Epiglottitis may progress to complete upper airway obstruction if not treated. Differential diagnosis includes acute infectious laryngitis, acute laryngotracheobronchitis (croup), acute spasmodic laryngitis, membranous (bacterial) tracheitis, anaphylactic reaction, foreign-body aspiration, retropharyngeal abscess, and extrinsic or intrinsic compression of the airway (tumors, trauma, cysts).