SESSION TYPE: Airway Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Unlike infectious epiglottitis, thermal epiglottitis is a rare condition. We present an interesting and rare case of thermal epiglottitis.
CASE PRESENTATION: 47 year old woman presented to the emergency room with acute stridor. Earlier she rolled a cigarette using tobacco leftovers from previously smoked cigarettes. She experienced lip and oropharyngeal burning followed by hypersalivation, stridor, voice changes, and dyspnea. A lateral xray of the neck demonstrated marked epiglottal swelling with airway narrowing. Direct laryngoscopy revealed severe supraglottic edema of the epiglottis and tracheal opening. She was intubated for airway protection using a bougie and 6.5 French endotracheal tube. Bronchoscopy showed no evidence of bronchial soot or inhalation injury. She was extubated 2 days later.
DISCUSSION: Thermal epiglottitis is a medical emergency. The radiographic and laryngoscopic findings are similar to those of infectious epiglottitis. In a series of 407 epiglottitis cases, Mayo-Smith et al. found only 4 cases of thermal epiglottitis, all from inhalation of heated objects when smoking illicit drugs. The symptoms were mostly sore throat, dysphagia, voice changes, drooling, and respiratory distress. The principles of management of thermal epiglottitis involve airway maintenance and antibiotics until an infectious etiology has been excluded. There is a consensus on placing an artificial airway in children with epiglottitis even in the absence of respiratory distress. In adults, a selective approach is followed. Adult patients with less than 50% laryngeal obstruction and absence of respiratory distress can be observed in the intensive care unit (ICU) without artificial airway. Prior to extubation, patients should demonstrate an endotracheal tube cuff leak and a resolution of edema on laryngoscopy. The role of steroids is controversial and was not associated with a reduction in length of stay, duration of intubation, or duration of ICU stay.
CONCLUSIONS: Thermal epiglottitis is an unusual cause of threatened airway obstruction. While the role of antibiotics and steroids is not clear, airway maintenance remains the mainstay of management.
1) Mayo-Smith MF, Spinale J. Thermal epiglottitis in adults: a new complication of illicit drug use. J Emerg Med. 1997 Jul-Aug;15(4):483-5.
2) Glynn F, Fenton JE. Diagnosis and management of supraglottitis (epiglottitis). Curr Infect Dis Rep. 2008 May;10(3):200-4.
3) Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. 1990 Feb;100(2 Pt 1):183-5.
DISCLOSURE: The following authors have nothing to disclose: Labib Debiane, George Nassif, Rami Zebian, Saadia Faiz, William Fisher
No Product/Research Disclosure InformationUniversity of Texas Health Science Center in Houston, Houston, TX