Since the Haemophilus influenzae vaccine became available in 1985 and gained widespread acceptance, the childhood incidence of epiglottitis has rapidly dropped. The relative inversion of the child-adult ratio has now partially returned the focus of this process to the adult community. More than 500 reports of adult epiglottitis, or supraglottitis, have been documented. The most common presenting symptoms seen in adults with epiglottitis are severe odonyphagia and dysphagia. All other symptoms are variable and include muffled voice, drooling, subjective fever, and cough.
Dyspnea occurs in fewer than one third of patients.
Elevated white blood cell counts and fever are often noted but are not consistent or predictive of the severity of the process. When cultures show positivity, H influenzae is the most common organism isolated. Other isolates include pneumococci, Haemophilus parainfluenzae , streptococci, staphylococci, and Serratia . Although adults may experience a rapid onset of symptoms, which is common in the pediatric form of epiglottitis, most adults experience 2 or more days between the onset and crescendo of symptoms before they seek medical care. It has been suggested that the larger and more rigid laryngeal airway in adults allows a greater ability to sustain inflammation without airway compromise.