title: Acute epiglottitis: a retrospective review of 47 patients in Kuwait.
abstract: OBJECTIVE
  Acute epiglottitis is a potentially life threatening condition which can lead to fatal airway obstruction in previously healthy individuals. The present study was undertaken to assess the clinical features, management and patient outcomes of epiglottitis in Kuwait over an eight year period.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Al Sabah Hospital, Kuwait.
  
  
  METHODS
  All patients admitted to the ENT department of Al Sabah hospital between January 2000 and January 2008 with the diagnosis of acute epiglottitis were included in this retrospective study. The diagnosis of acute epiglottitis was established by visualization of inflamed epiglottis either on indirect laryngoscopy or flexible fibreoptic/direct laryngoscopy.
  
  
  RESULTS
  47 cases were identified, 5 children and 42 adults. There were 32 males and 15 females, in the age range of 5 to 66 years. Peak incidence was in the third decade. 31 patients had co-morbid conditions, 18 patients (38.2%) had diabetes, 8 patients (17%) had hypertension and 3 patients (6.3%) had dental caries. Majority of the patients (89.3%) presented with sore throat as their chief complaint. All patients were febrile on presentation. The classical "thumb sign" on lateral neck radiograph was seen in 32 patients (68%). Blood cultures were collected from 22 patients (46.8%), all were negative. Ceftriaxone was the commonest empirical antibiotic prescribed. 7 patients required airway intervention (5 with endotracheal intubation and 2 with tracheostomy). There were no deaths in our study.
  
  
  CONCLUSIONS
  In Kuwait, acute epiglottis is commoner in adults than in children. It is imperative to secure the airway and to start the patients on broad spectrum antibiotics and steroids as early as possible. In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention, in the form of intubation / tracheostomy, for patients with stridor or shortness of breath.
authors.affiliation: Department of ENT, Zain and Al Sabah Hospitals, P O Box 4078, Safat, Kuwait, 13041 Kuwait.
authors.forename: Imtiaz Majid
authors.initials: IM
authors.lastname: Qazi
authors.forename: Abdul Mohsin
authors.initials: AM
authors.lastname: Jafar
authors.forename: Khalid Al Abdul
authors.initials: KA
authors.lastname: Hadi
authors.forename: Zakir
authors.initials: Z
authors.lastname: Hussain
keywords: Acute epiglottitis; Airway; Complications; H influenzae; Tracheostomy