Diagnosis of Supraglottitis in the Post-Immunization Era

What are the demographics, presentation, interventions and outcomes of acute supraglottitis in the era following widespread immunization against Haemophilus influenza type b?

Background: The overall incidence of acute supraglottitis has decreased significantly since the introduction of the conjugated Haemophilus influenza type b (Hib) vaccine in 1988 and its widespread use by 1995. While there has been a marked decrease in the pediatric cases, some studies have identified new challenges in recognizing adult supraglottitis.

Study design: Retrospective review

Setting: Georgetown University Hospital and Washington Hospital Center, Washington, D.C.

Synopsis: Sixty adults and one child were identified at the two hospitals between 1995 and 2005, with the most common presenting symptom being odynophagia (100 percent), followed by dysphagia (85 percent) and voice change (75 percent). Thirteen patients required airway intervention, and 62 percent of patients were admitted to the ICU. All patients were treated with antibiotics, and 87 percent received at least one dose of steroids.

The average overall length of stay (LOS) was four days; for the 38 patients admitted to the ICU, average LOS was 2.3 days. Patients who received steroids spent a significantly shorter time in the ICU and had a shorter overall LOS.

According to the researchers, the less acute course of supraglottitis seen today makes it challenging to determine which patients require airway intervention and which can be safely observed. In the study, they found that presentation with stridor and respiratory distress was strongly associated with an increased need for airway intervention. Additionally, the researchers found that more subtle signs and symptoms, such as subjective shortness of breath, tachypnea and tachycardia, were indicative of a more serious clinical course.

Bottom line: Supraglottitis today is a different entity than that seen before the Hib vaccine and now occurs primarily in the adult population. Recognizing the signs and symptoms associated with airway obstruction is important in the management of this condition.

Citation: Guardiani E, Bliss M, Harley E. Supraglottitis in the era following widespread immunization against Haemophilus influenzaetype B: evolving principles in diagnosis and management. Laryngoscope. 2010; 120(11):2183-2188.

—Reviewed by Sue Pondrom