title: The rising incidence of adult acute epiglottitis and epiglottic abscess.
abstract: OBJECTIVE
  To examine preliminary observations that the incidence of adult acute epiglottitis has risen between 1986 and 2000.
  
  
  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.
authors: Department of Otolaryngology-Head and Neck Surgery, Meir Hospital, Sapit Medical Center, Kfar Saba, Tel Aviv, Israel. berger-g@zahav.net.il
authors: Gilead
authors: G
authors: Berger
authors: Tali
authors: T
authors: Landau
authors: Sivan
authors: S
authors: Berger
authors: Yehuda
authors: Y
authors: Finkelstein
authors: Joelle
authors: J
authors: Bernheim
authors: Dov
authors: D
authors: Ophir
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003710:Demography; D004826:Epiglottitis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012621:Seasons; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents