青柳 優：急性喉頭蓋炎 -リスクマネージメントから考える-、喉頭、17：55、2005.
田中是, 菊池茂, 大畑敦, ほか. 急性喉頭蓋炎285例の臨床的検討. 日耳鼻, 2015; 118(11): 1301-8.
E G Kass, E A McFadden, S Jacobson, R J Toohill
Acute epiglottitis in the adult: experience with a seasonal presentation.
Laryngoscope. 1993 Aug;103(8):841-4. doi: 10.1288/00005537-199308000-00002.
Abstract/Text
Acute epiglottitis in adults may follow an unpredictable clinical course, complicated by acute airway obstruction. Our experience with this disease was evaluated by looking at yearly incidence, seasonal occurrence, and clinical variables of both intubated and conservatively managed patients. In our series of 17 cases from 1987 through 1990, 16 occurred in 1988 and 1989. Ten of 17 cases occurred during the summer months. The two patients who developed stridor went on to require intubation and tracheotomy. Statistical analysis of our data revealed that, in adult acute epiglottitis, stridor is a strong predictor of airway obstruction. A significant summer seasonal predominance was seen, as well as a suggestion of an epidemic in 1988 and 1989.
Gilead Berger, Tali Landau, Sivan Berger, Yehuda Finkelstein, Joelle Bernheim, Dov Ophir
The rising incidence of adult acute epiglottitis and epiglottic abscess.
Am J Otolaryngol. 2003 Nov-Dec;24(6):374-83.
Abstract/Text
OBJECTIVE: To examine preliminary observations that the incidence of adult acute epiglottitis has risen between 1986 and 2000.
MATERIALS AND METHODS: Demographics, annual and seasonal occurrences, clinical presentation, diagnostic procedures, treatment, airway management, and complications of 116 consecutive adult patients with laryngoscopically confirmed acute epiglottitis are presented.
RESULTS: The mean annual incidence of acute epiglottitis per 100,000 adults significantly increased from 0.88 (from 1986-1990) to 2.1 (from 1991-1995) and to 3.1 (from 1996-2000) (P <.001). This rise seems to be unrelated to Haemophilus influenzae type b infection but related to miscellaneous pathogenic bacteria. During these periods, the number of epiglottic abscesses increased concomitantly with the rise in the incidence of acute epiglottitis (from 4/14 episodes [29%], to 8/38 [21%], and to 16/66 [24%], respectively), showing a relatively constant ratio between both phenomena (P =.843). Twenty-five patients (21%) underwent airway intervention, 16 because of objective respiratory distress and 9 because of imminent respiratory obstruction. Stepwise logistic regression showed that drooling, diabetes mellitus, rapid onset of symptoms, and abscess formation were associated with airway obstruction. Diverse origins for the epiglottic abscess, either from coalescent epiglottic infection or from mucopyocele of the tongue base, are suggested.
CONCLUSIONS: A rise in the incidence of acute epiglottitis and a concomitant rise in the number of epiglottic abscesses were established. Although the course of acute epiglottitis is often benign and can be safely treated with a conservative management approach, delayed airway obstruction may develop from a few hours to days after admission.
鈴木賢二：急性喉頭蓋炎の診療 薬物治療 ENTONI(1346-2067)、2004；40号 Page30-34.
Mohannad Al-Qudah, S Shetty, M Alomari, Maen Alqdah
Acute adult supraglottitis: current management and treatment.
South Med J. 2010 Aug;103(8):800-4. doi: 10.1097/SMJ.0b013e3181e538d8.
Abstract/Text
Acute adult supraglottitis can be a serious, life-threatening disease because of its potential for sudden upper airway obstruction. Symptoms and signs of this disease may be nonspecific and may resemble those of upper respiratory tract infection. Unexplained sore throat with tenderness of the anterior neck over the hyoid bone warrant careful examination by flexible laryngoscopy to rule out laryngeal congestion and edema. Laboratory tests are usually not helpful in picking up the diagnosis. Following diagnosis, patients should be hospitalized, started on intravenous antibiotics and their airway closely monitored, as airway obstruction may develop.
Anders Sideris, Timothy R Holmes, Benjamin Cumming, Thomas Havas
A systematic review and meta-analysis of predictors of airway intervention in adult epiglottitis.
Laryngoscope. 2020 Feb;130(2):465-473. doi: 10.1002/lary.28076. Epub 2019 Jun 7.
Abstract/Text
OBJECTIVE: Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease.
METHODS: The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random-effects model meta-analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention.
RESULTS: Thirty studies and a total of 10,148 patients were finally included for meta-analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention.
CONCLUSION: In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention.
LEVEL OF EVIDENCE: NA Laryngoscope, 130:465-473, 2020.
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
Anton W G Booth, Karla Pungsornruk, Stacey Llewellyn, David Sturgess, Kim Vidhani
Airway management of adult epiglottitis: a systematic review and meta-analysis.
BJA Open. 2024 Mar;9:100250. doi: 10.1016/j.bjao.2023.100250. Epub 2024 Jan 5.
Abstract/Text
BACKGROUND: Adult epiglottitis is a life-threatening airway emergency where airway protection is the immediate priority. Despite its importance, the optimal approach to airway management remains unclear. We performed a systematic review of the airway management for adult epiglottitis, including meta-analysis of trends over time.
METHODS: We systematically searched PubMed, Ovid MEDLINE®, and Embase® for adult epiglottitis studies that described the airway management between 1980 and 2020. The primary outcome was the prevalence of airway intervention. Secondary outcomes were prevalence of tracheal intubation, tracheostomy, and failed intubation. A random-effects model meta-analysis was performed with subgroups defined by decade of study publication. Cases that described the specific method of airway intervention and severity of epiglottitis were included in a separate technique summary.
RESULTS: Fifty-six studies with 10 630 patients were included in the meta-analysis. The overall rate of airway intervention was 15.6% (95% confidence interval [CI] 12.9-18.8%) but the rate decreased from 20% to 10% between 1980 and 2020. The overall rate of tracheal intubation was 10.2% (95% CI 7.1-13.6%) and that of failed intubation was 4.2% (95% CI 1.4-8.0%). The airway technique summary included 128 cases, of which 75 (58.6%) were performed awake and 53 (41.4%) involved general anaesthesia. We identified 32 cases of primary technique failure.
CONCLUSION: The rate of airway intervention for adult epiglottitis has decreased over four decades to a current level of 10%. Tracheal intubation is a high-risk scenario with a 1 in 25 failure rate. Specific technique selection is most likely influenced by contextual factors including the severity of epiglottitis.
© 2023 The Author(s).
菊地正弘、西田吉直：急性喉頭蓋炎の病期分類 MB ENT、2004；40:40-24.
Hideaki Katori, Mamoru Tsukuda
Acute epiglottitis: analysis of factors associated with airway intervention.
J Laryngol Otol. 2005 Dec;119(12):967-72. doi: 10.1258/002221505775010823.
Abstract/Text
We reviewed acute epiglottitis (AE) and identified factors associated with airway intervention. This report was a retrospective review of patients with AE and compared with factors associated with airway intervention. We reviewed 96 patients who were diagnosed with AE in our hospitals in Japan. Ninety-two (96 per cent) patients were adults, and no seasonal variation in the incidence of AE was encountered. Eight (8 per cent) patients had tracheostomy and endotracheal intubation had not been done. We found that symptoms of stridor and muffled voice, a rapid clinical course, and diabetes mellitus were the factors associated with airway intervention. Extremely severe swelling of the epiglottis such that only less than half of the posterior vocal fold (scope classification (SC): III) could be seen, and extension of the swelling to the arytenoids (SC: B) were the two factors that were strongly associated with airway intervention.
橋本大門、八尾和雄、西山耕一郎、井口芳明、正来隆、堀口利之、岡本牧人；急性喉頭蓋炎に対する気道確保の検討 耳鼻咽喉科臨床(0032-6313)、2006；99巻1号 Page25-30.
川嶋隆久：成人急性喉頭蓋炎と気道確保について 喉頭2005；17:56-60.
吉福孝介, 大堀純一郎, 宮下圭一, ほか：成人急性喉頭蓋炎に対する喉頭蓋乱切術の有用性について. 日耳鼻感染症研会誌, 2013; 31(1): 125-8.
平出文久、栫博幸：急性喉頭蓋炎の臨床的検討 栃木県内の開業医に対してのアンケート調査の結果、日本気管食道科学会会報(0029-0645)、1990；41巻3号 Page189-195.
