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At least 19 recordsLinked to original sources
PubMed1991

Correlation of performance with endoscopic and radiographic assessment of epiglottic hypoplasia in racehorses with epiglottic entrapment corrected by use of contact neodymium:yttrium aluminum garnet laser.

Epiglottic entrapment in 35 Thoroughbred and 44 Standardbred horses was corrected transendoscopically by use of a neodymium:yttrium aluminum garnet laser. Before surgery, the entrapped epiglottis was classified as hypoplastic or normal in each horse on the basis of endoscopic appearance alone. Using a digitizer, thyroepiglottic length was determined from lateral-view laryngeal radiographs. For 78 racehorses, earnings (less than $5,000 or greater than $5,000) were compared before and after surgery. Earnings category and racing performance after surgery were tested for association with endoscopically determined epiglottic hypoplasia and radiographically determined thyroepiglottic length. Endoscopy and radiography were useful methods of evaluating the epiglottis in horses with epiglottic entrapment. Mean (+/- SD) thyroepiglottic length for both breeds of horses with epiglottic entrapment was significantly (P = 0.0001) smaller (Thoroughbreds, 7.28 +/- 0.67 cm; Standardbreds, 7.21 +/- 0.62 cm), compared with thyroepiglottic length measured from control groups composed of clinically normal Thoroughbred (8.56 +/- 0.29 cm) and Standardbred (8.74 +/- 0.38 cm) racehorses. Both breeds of horses with epiglottic entrapment that had endoscopically apparent hypoplastic epiglottis had significantly (P less than 0.0001) smaller thyroepiglottic length (Thoroughbreds, 6.64 +/- 0.60 cm; Standardbred, 6.93 +/- 0.72 cm) than did horses with epiglottic entrapment that had endoscopically normal epiglottis (Throughbreds, 7.57 +/- 0.47 cm, Standardbreds, 7.36 +/- 0.50 cm). Significant difference was not detected in endoscopic appearance of the epiglottis among age, gender, or breed distributions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Evaluation of epiglottic augmentation by use of polytetrafluoroethylene paste in horses.

Epiglottic augmentation was evaluated in 7 horses, using 7 ml of polytetrafluoroethylene (polytef) paste injected submucosally on the ventral surface of the epiglottis. In 6 horses, an Arnold-Bruning intracordal injection syringe, specifically designed to inject polytef into paralyzed vocal folds in human beings, was used. At necropsy 60 days after surgery, group mean thickness measurement 20 mm from the epiglottic tip was 40% greater (P less than 0.01) and, at the epiglottic attachment of the aryepiglottic fold, was 29% greater (P less than 0.01) in the 6 polytef-augmented horses than in clinically normal nonsurgically treated controls. At necropsy, extensive epiglottic thickening was seen. This thickening was exclusively attributable to distention of submucosal areas in the ventral aspect of the epiglottis, with foreign body granulomata surrounded by fibrous connective tissue. In 1 horse, polytef paste was injected by use of a disposable syringe and needle. Excess ventral epiglottic swelling and exposed epiglottic cartilage was seen during subsequent endoscopy. At necropsy 60 days after surgery, the epiglottic contour remained deformed and a large deep mucosal ulcer was observed at the injection site. Histologic examination revealed necrotizing suppurative inflammation that extended into the epiglottic cartilage. Surgery was not technically difficult to perform through a laryngotomy, and all horses tolerated the procedure without apparent discomfort. Endoscopy performed after surgery revealed unremarkable and uniform response to the polytef paste in 4 horses, and in 3 horses, revealed excess swelling and inflammation of the ventral epiglottic tissue that resolved over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Radiologic diagnosis of epiglottitis: objective criteria for all ages.

A retrospective study was undertaken to define objective radiologic parameters in diagnosing epiglottitis on soft-tissue lateral neck radiographic studies. Ratios of soft-tissue structures in 31 patients aged 7 months to 61 years with epiglottitis were compared with those of age- and sex-matched controls with croup, pharyngitis, and dysphagia. The ratios of epiglottic width to third cervical vertebral body width (EW/C3W) of more than 0.5, of aryepiglottic width to third cervical vertebral body width (AEW/C3W) of more than 0.35, and of epiglottic width to epiglottic height (EW/EH) of 0.6 or more were all found to be 100% sensitive and specific in differentiating between adult patients with and without epiglottitis. In children, EW/C3W, AEW/C3W, and EW/EH ratios of more than 0.5, of more than 0.35, and of 0.6 or more, respectively, were found to be 100% sensitive in detecting epiglottitis with specificities of 87%, 96%, and 87% respectively. These preliminary results suggest that EW/C3W, EW/EH, and AEW/C3W ratios of more than 0.5, of 0.6 or more, and of more than 0.35, respectively, may be useful in the radiologic diagnosis of epiglottitis in patients of all ages.

Adolescent↗
PubMed1990

Transendoscopic contact neodymium:yttrium aluminum garnet laser correction of epiglottic entrapment in standing horses.

Fifty-seven Standardbred and 44 Thoroughbred racehorses and 1 Thoroughbred polo mare with primary clinical signs of exercise intolerance or respiratory tract noise or combined exercise intolerance and respiratory tract noise were referred for laser correction of epiglottic entrapment. Significantly (P less than 0.001) more Standardbred than Thoroughbred racehorses were affected, compared with the observed hospital population during the same period. At referral, 14 horses did not have evident epiglottic entrapment and were returned to exercise without development of entrapment after treatment, which consisted of 1 week of rest and administration of anti-inflammatory medication. In 88 standing horses under sedation and topical anesthesia, epiglottic entrapment was corrected transendoscopically by use of a contact neodymium:yttrium aluminum garnet laser. In these 88 horses, 98% of entrapments were persistent, 92% were thick, 97% were wide, and 45% were ulcerated. Thirty-one percent of the horses had endoscopic evidence of epiglottic hypoplasia, and 8% had deviated epiglottic axis. Complete correction was achieved in 97% of the horses, Persistent dorsal displacement of the soft palate in 1 horse and severe epiglottic hypoplasia with thick, chronic entrapping membranes in 2 horses precluded successful transendoscopic correction with the horses in standing position. Most horses were treated on an outpatient basis, and all were able to be returned to exercise after 7 to 14 days of rest and treatment with anti-inflammatory medication. Entrapment recurred in 4 horses (5%), 3 of which had hypoplastic epiglottis. Dorsal displacement of the soft palate developed after surgery in 9 horses (10%) and continued in 4 horses (5%) that had displaced soft palate before surgery. All these horses had epiglottic hypoplasia. Laser correction of epiglottic entrapment in standing horses was safe, well tolerated, and effective. Laser surgery was an alternative to conventional surgery, and eliminated the need for general anesthesia and laryngotomy. It also reduced convalescence and postoperative complications.

Airway Obstruction↗
PubMed1992

A changing pattern of epiglottitis.

A case review of epiglottitis at Geisinger Medical Center over the past 12 years demonstrates a decrease in the number of pediatric patients with epiglottitis and an increase in the number of adults with epiglottitis. In the last five years, the number of epiglottitis patients younger than 10 years has fallen (0 cases), while the number of patients over 10 years of age has increased (6 cases). The cause of epiglottitis, Hemophilus influenzae type b, remains constant in the pediatric as well as in the adult population. There appears to be an increasing frequency of epiglottitis in adults and a decreasing frequency of epiglottitis in children.

Adult↗
PubMed1989

Epiglottitis in infants less than two years of age.

A retrospective review of 41 children less than two years of age was conducted to characterize the clinical presentation of epiglottitis in this young age group. Up to 25% of all cases of epiglottitis occur in children less than two years of age. The clinical presentation of patients in this young age group is variable. Signs and symptoms not routinely described in children over two years of age with epiglottitis but often observed in infants with epiglottitis include the absence of fever, the presence of only low grade fever, a significant history of antecedent URI, and a prominent "croupy" cough. These same features are often noted in children with the viral croup syndrome. A diagnosis of this life-threatening illness may be made promptly through an awareness of the presenting findings observed in infants. Young infants with epiglottitis can be safely managed with short-term nasotracheal intubation.

Airway Obstruction↗
PubMed1992

The relationship of vallecular residue to oral involvement, reduced hyoid elevation, and epiglottic function.

The purpose of this investigation was to identify certain variables that may result in vallecular residue after swallowing. The relationship between vallecular residue and oral-stage dysphagia, reduced hyoid elevation, and movement of the epiglottis was assessed in 330 patients referred to the speech pathology section for evaluation of oropharyngeal swallowing function. Patients with vallecular residue were more likely to have oral involvement or deviant epiglottic function, characterized by an absence of epiglottic inversion or incomplete inversion, than patients without vallecular residue. Although the primary focus of the study was between vallecular residue and the other select variables, the interrelationships among the three other variables were also studied. Patients with deviant epiglottic function were more likely to have oral involvement, reduced hyoid elevation, or vallecular residue than patients without deviant epiglottic function and patients with reduced hyoid elevation were more likely to have oral involvement than those with normal hyoid elevation. Multivariate analysis revealed that the relationship between oral involvement and deviant epiglottic function, present in the bivariate analysis, was not significant when controlling for other relationships in the model. The relationship between primary medical diagnostic category and the presence/absence of vallecular residue as well as the other dichotomous variables varied between and within diagnostic categories.

Adult↗
PubMedDate not supplied

Adult epiglottitis.

Adult epiglottitis (or "supraglottitis") is an uncommon but increasingly recognized entity. Though prior studies emphasized the fulminant nature of the disease, recent evidence suggests that epiglottitis in adults may follow a relatively less severe clinical course, especially if Hemophilus influenza is not isolated. The records of 28 patients with adult epiglottitis were retrospectively analyzed to characterize the presenting features and clinical course of the disease. The diagnosis was established by laryngoscopy, lateral cervical radiographs, or both. Laryngoscopy did not precipitate airway obstruction in any patient. The majority of patients experienced a relatively benign clinical course and improved with medical management that consisted of ICU admission, intravenous antibiotics, hydration, inhaled mist, and corticosteroids. Only two patients (7%) required airway support with orotracheal intubation because of respiratory difficulty. There were no instances of respiratory arrest or airway obstruction. No tracheostomies were performed, and there were no deaths. It was concluded that adult epiglottitis can follow a less severe course than classically described.

Adolescent↗
PubMed1992

Acute epiglottitis--25 years experience with nasotracheal intubation, current management policy and future trends.

During a 25-year period 168 adults and 111 children in Copenhagen County were treated for acute epiglottitis. Four patients, two children and two adults died, of these the two children and one adult had a cardiac arrest on arriving at the hospital. Most children were treated by nasotracheal intubation while only some adults required nasotracheal intubation in order to secure the airway. Our data indicate that intubation of adults with epiglottitis is technically more difficult than in children. The fibrelaryngoscope, a new diagnostic tool, is advocated, and was in this study used to establish the diagnosis in 12 unclear cases of acute epiglottitis. The incidence of acute epiglottitis in children was calculated at 3.2/100,000 with a minor annual variation. As vaccination against Haemophilus influenzae type b becomes more common, the incidence will probably be markedly reduced, maybe even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b.

Acute Disease↗
PubMed1991

[Clinical aspects of acute epiglottitis in adults].

During the last three years, 79 adults suffering from acute epiglottitis have been treated in the ENT departments of the university hospital Rudolf Virchow, Berlin, 36 women (41 years of age as an average) and 43 men (average age 39 years). Acute epiglottitis developed either all of a sudden, within hours, or gradually, within days. All patients complained of dysphagia and pain in the throat; dyspnea could be observed in 20%. During examination, we could see an inflamed, thickened epiglottis with edema of the arytenoid cartilages. 55 patients reported an infection of the upper airway prior to the onset of symptoms of acute epiglottitis, epiglottic abscess developed in 11 adults. The inflammation responded satisfactorily to conservative antibiotic management (broad spectrum penicillin). Only one patient had to undergo intubation, none of the adults required tracheotomy.

Acute Disease↗
PubMedDate not supplied

Sulbactam/ampicillin in the treatment of acute epiglottitis in children.

Acute epiglottitis, a life-threatening illness, is characterized by the sudden onset and rapid progression of respiratory obstruction. The etiologic agent is almost exclusively Haemophilus influenzae type b (Hib). During the past decade as many as 25% of strains of Hib have been shown to produce beta-lactamase and be resistant to ampicillin. Recommendations for treatment, in addition to the immediate intubation of the airway, include the administration of chloramphenicol in combination with ampicillin. The combination of sulbactam and ampicillin was evaluated in an effort to develop a safer, but equally effective, regimen. Thirty-one infants and children (mean age, three years six months) with documented acute epiglottitis received parenteral sulbactam sodium (30 mg/kg per day) in combination with ampicillin (200 mg/kg per day). Of the 31 subjects, 26 (84%) had Hib isolated from the blood; seven (27%) of the 26 strains of Hib isolated were beta-lactamase-positive. Twenty-five cases (96%) of Hib epiglottitis responded rapidly to treatment. The combination of sulbactam and ampicillin appeared to be an effective and safe alternative to chloramphenicol/ampicillin therapy for acute epiglottitis in infants and children.

Acute Disease↗
PubMed1992

Thermal epiglottitis after swallowing hot tea.

Acute infectious epiglottitis in children is a well-recognized clinical entity. We report the development of acute thermal epiglottitis after ingestion of hot tea by a three-year-old patient. Clinical and radiographic findings in our patient and others reported in the literature resemble acute infectious epiglottitis. In all cases of burns around the mouth, the possibility of intraoral and respiratory damage must be considered. Because of the high risk of upper airway obstruction, children in whom thermal epiglottitis is suspected should be observed in the intensive care unit and have appropriate airway management.

Acute Disease↗
PubMed1989

Recurrent adult acute epiglottitis: the role of lingual tonsillectomy.

Acute epiglottitis is a life-threatening infection of the supraglottic airway that can occur at any age. Although it is traditionally described as a childhood infection, recent reports describe an increased recognition of this problem in adults. When appropriate and timely therapy is instituted, this condition is generally self-limited. Recurrent acute epiglottitis is exceedingly uncommon, and its treatment rarely is addressed. We encountered and treated a case of recurrent acute epiglottitis in an adult. After the third recurrence, careful consideration was given to possible pathophysiologic mechanisms and potential therapeutic options. Further recurrence was prevented effectively by performing a lingual tonsillectomy. Although this is an unusual condition, the cause of recurrent acute epiglottitis may be related to chronic lingual tonsillitis. Lingual tonsillectomy in these cases may help prevent further recurrent episodes.

Acute Disease↗
PubMed1990

Epiglottitis in the adult.

Much attention has been directed toward the etiology, diagnosis, and management of pediatric epiglottitis. Recently, however, the otolaryngological literature has stressed the importance of recognizing epiglottitis (or supraglottitis) as an adult affliction. Two interesting cases of adult epiglottitis are presented, emphasizing the many differences between the adult and pediatric forms concerning the presentation, diagnosis, treatment, and natural course of the disease. Controversies regarding the diagnosis and management are addressed, as well as the indications for and types of airway intervention. A review of the complications of epiglottitis and their treatment is included.

Diagnosis, Differential↗
PubMed1990

Epiglottic dysfunction after isocyanate inhalation exposure.

Epiglottic dysfunction due to environmental exposure is a well-known entity. The most common causes of epiglottic dysfunction include trauma (thermal, chemical, and blunt), infection, allergy, neoplasm, and neurologic disorders. We report an unusual case of epiglottic dysfunction due to isocyanate inhalation exposure and review the literature concerning this subject. Following inhalation exposure to diphenylmethane diisocyanate, our patient developed persistent repeated airway obstruction during inspiration. Fiberoptic rhinolaryngoscopy showed that the epiglottis obstructed the glottic airway during each inspiratory cycle. The epiglottic dysfunction was also well demonstrated by barium contrast cineradiography. Total epiglottectomy resulted in resolution of the patient's upper airway obstructive symptoms. Histologically, marked inflammatory changes of the epiglottis were noted, including a focal infiltrative pattern, focal fibrosis, edema, and reactive changes.

Adult↗