Management of adult supraglottitis requires conservative judgment, with early intervention. Any sign of airway instability requires urgent operative management of the airway with either endotracheal intubation or tracheotomy. If the airway is stable, the patient may be treated with appropriate intravenous broad-spectrum antibiotic therapy and intensive care monitoring. It is important to note that sudden airway compromise has been reported in patients with epiglottitis within hours after admission. Therefore, a surgical team must be available at all times, with appropriate emergency instruments at the bedside.
Epiglottic abscess occurs almost exclusively in the setting of acute adult epiglottitis and is rare.
Overall, fewer than 50 cases have been reported in the English-language literature. Treatment for epiglottic abscess includes immediate operative airway management, drainage, and antibiotic therapy. Failure to drain an abscess could potentially lead to a delayed response to antibiotics and a prolonged course of treatment. The mortality rate remains significantly higher in adults than in children, however, despite the more aggressive course of pediatric disease. This underscores the importance of early conservative management and vigilance in cases in which elective monitoring is chosen.