ABSTRACT
We report four cases of acute epiglottitis with a peritonsillar abscess originating from the inferior pole of the palatine tonsil. All cases were male, and presented with acute onset of sore throat and dysphagia. Flexible laryngoscopy revealed swollen epiglottis and swelling at the base of tongue along the edge of the epiglottis in all cases. Computed tomography (CT) revealed the position and extent of a peritonsillar abscess. Surgical drainage was not performed. Abscesses decreased in size following intravenous antibiotics and corticosteroids. We surmise that inflammatory exudates extending widely in the pre-epiglottic space cause epiglottic swelling from oropharyngeal infection, the latter of which is thought to produce a peritonsillar abscess. We recommend CT examination for patients with a stable airway and swollen epiglottis, even if the swelling is mild. This will allow for exclusion of deep neck abscess and determination of the most effective treatment including intravenous antibiotics against anaerobe, incision and drainage of an abscess.
Subject(s)
Epiglottitis/diagnosis , Peritonsillar Abscess/diagnosis , Acute Disease , Adrenal Cortex Hormones/administration & dosage , Adult , Anti-Bacterial Agents/administration & dosage , Drug Therapy, Combination , Humans , Infusions, Intravenous , Laryngoscopy , Male , Middle Aged , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes , Tomography, X-Ray ComputedABSTRACT
The motor system is extensively affected in amyotrophic lateral sclerosis (ALS). Rapid disease progression almost certainly ensures that about half of thsese cases will experience respiratory muscle paralysis to breathe within about five years. We report two cases of ALS involving upper airway obstruction. Fiberoptic laryngoscopy showed floppy epiglottis, tilted posteriorly and horizontally and impacting against the posterior pharyngeal wall during inspiration. Several months later, airway obstruction grew exceedingly worse, and the tilted epiglottis did not return to its vertical resting position. Tracheostomy was conducted during this period. We found that laryngoscopy may be useful in the evaluation of upper airway obstruction, and it may be safer to avoid continuous positive airway pressure.
