Clinical Findings for Epiglottitis
Epiglottitis presents with sudden onset of severe sore throat and odynophagia (painful swallowing), with potential for rapid progression to life-threatening airway obstruction requiring immediate recognition and intervention. 1
Cardinal Presenting Symptoms
- Odynophagia (painful swallowing) is the most consistent finding, present in 100% of adult cases 2
- Inability to swallow secretions occurs in 83% of patients, often manifesting as drooling 2, 3
- Sore throat is reported in 67-89% of cases as the chief complaint 2, 4
- Dyspnea develops in 58% of patients, indicating progressive airway compromise 2
- Hoarseness or muffled voice occurs in 50% of cases 2, 3
Physical Examination Findings
- Fever (>37.2°C) is present in 75% of patients at presentation 2, 4
- Tachycardia (>100 bpm) occurs in 50% of cases 2
- Stridor is present in only 42% of adult cases, making it an unreliable sign that should not be used to rule out epiglottitis 2
- The classic "tripod position" (sitting upright, leaning forward with neck extended) may be observed in patients attempting to maximize airway patency 3
- A normal oropharyngeal examination does not exclude epiglottitis—44% of patients have a normal-appearing oropharynx on routine examination 2
Diagnostic Visualization
- Direct visualization by laryngoscopy (flexible fiberoptic or direct) is the gold standard, revealing a swollen, cherry-red epiglottis 1, 5, 2
- The "thumb sign" on lateral neck radiograph is seen in 68% of cases, showing an enlarged epiglottis resembling a thumb 4
Critical Clinical Pitfalls to Avoid
- Never attempt throat examination with a tongue depressor in suspected epiglottitis, as this may precipitate complete airway obstruction 1, 6
- Do not rely on the absence of stridor to rule out epiglottitis, as the majority of adult patients lack this finding 2
- Avoid swabbing the throat for cultures, as manipulation can trigger sudden airway occlusion; blood cultures are the preferred diagnostic sample 7, 1
- Do not delay diagnosis based on normal oropharyngeal appearance—nearly half of patients have unremarkable routine throat exams 2
Associated Risk Factors
- Diabetes mellitus is present in 38% of adult cases, representing the most common comorbidity 4
- Hypertension occurs in 17% of patients 4
- Peak incidence in adults is in the third decade of life, though it can occur at any age 4
Clinical Course and Severity
- Adult epiglottitis often presents with a milder and more variable clinical course compared to pediatric cases, which can lead to delayed recognition and diagnosis 5, 8
- Mortality in adults remains approximately 7%, significantly higher than the 1% mortality in pediatric populations with aggressive management 5
- Airway intervention (intubation or tracheostomy) is required in approximately 15% of adult cases 4