What is the management of common ENT emergencies such as acute epiglottitis or severe deep neck infections?

Management of Common ENT Emergencies: Acute Epiglottitis and Deep Neck Infections

Acute Epiglottitis Management

The management of acute epiglottitis requires immediate airway assessment, hospitalization in an intensive care setting, and early intervention for airway management in cases showing respiratory distress or progressive symptoms. 1

Diagnosis

• Gold standard: Direct visualization by laryngoscopy 1
• Alternative: Lateral neck X-rays (though less sensitive than direct visualization) 1, 2
• Universal symptom: Painful dysphagia 3
• Warning signs: Respiratory distress, oxygen desaturation, laryngeal edema 4

Management Algorithm

1. Immediate assessment:

   • Evaluate airway patency and respiratory status
   • Perform careful laryngoscopy to confirm diagnosis
   • Monitor oxygen saturation continuously

2. Airway management:

   • For patients with respiratory distress (seen in approximately 67% of adult cases 3):
     • Prepare for immediate airway intervention
     • Options include endotracheal intubation under general anesthesia 2 or tracheostomy 4, 5
   • For stable patients:
     • Close monitoring in ICU setting
     • Be prepared for sudden deterioration 4

3. Medical therapy:

   • Antibiotics: Immediate parenteral administration 2, 3
     • Target Haemophilus influenzae type B (found in 97% of pediatric cases 2) and other potential pathogens
   • Adjunctive treatments:
     • Steroids (used in 83% of cases in one study 3)
     • Nebulized adrenaline may help avoid airway intervention in some cases 3

Important Considerations

• Adult epiglottitis differs from pediatric cases:

  • Often presents with milder clinical course but maintains 7% mortality rate 1
  • Can deteriorate rapidly despite initial mild presentation 4

• Critical pitfall: Mistaking epiglottitis for common sore throat

  • This condition must be distinguished from more common causes of severe sore throat 3
  • Delay in diagnosis can be fatal

• Facility requirements: Patient should be managed in a unit with facilities and expertise for acute airway intervention 3

Deep Neck Infections

While the provided evidence focuses primarily on acute epiglottitis, the principles of management for deep neck infections include:

• Early diagnosis with imaging (CT with contrast)
• Prompt surgical drainage for collections
• Broad-spectrum antibiotics
• Airway monitoring and management as needed

Warning

Even if initial findings appear mild, patients must be monitored closely as deterioration can occur despite treatment 4. The threshold for airway intervention should be low when signs of respiratory compromise are present.