No infection of the upper respiratory tract is more rapidly progressive or more lethal than acute epiglottitis, also known as supraglottis. Acute epiglottitis occurs most commonly in children between 2 and 8 years of age and is more frequent in boys. Although uncommon, acute epiglottitis in adults is being recognized with increasing frequency. In adults, involvement often extends to the supraglottic structures, and edema may be more prominent than acute inflammation. The course of the disease in adults is slower than in children, often extending over several days because of the larger diameter of the adult airway.
Acute epiglottitis is a medical emergency.
The key to the diagnosis is a swollen, edematous, cherry-red epiglottis. Simple inspection of the pharynx is usually unrewarding. Furthermore, any instrumentation, even a tongue blade, can provoke spasm and total airway obstruction, though adults are at lower risk for this complication. In all cases, patients must be monitored continuously for signs of respiratory obstruction. Although tracheostomy is the traditional means of securing a patent airway in these patients, nasotracheal intubation is safe and effective.