This Japanese study was a retrospective review of 83 patients admitted with epiglottitis over a 9.5-year period. The authors found that the factors that were significantly more likely to be present in patients who received airway intervention were: odynophagia; drooling; hoarseness; muffled voice; dyspnoea; swelling of the posterior side of the epiglottis; less than 50% of the glottis area being visible by flexible laryngoscopy; and a raised white cell count. The only factor that was shown by multiple logistic regression to be distinctively predictive of airway intervention was: less than 50% of the glottis area being visible (sensitivity of 86.6% and specificity of 78.6%). Airway intervention was performed in 16/83 patients (19%), and in all but one patient involved a tracheostomy. There are currently no clear guidelines regarding when airway intervention should proceed in a patient with epiglottitis, but this is normally decided via a reasoned discussion between the ENT and anaesthetic team depending on clinical and examination findings. However, the results from this study can act to help in that decision-making process.

Airway intervention in cases of acute epiglottitis.
Shimizu Y, Mori E, Wada K, et al.
B-ENT
2016;12:279-84.
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Sunil Sharma

Great Ormond Street Hospital, UK.

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