Clinical Manifestations and Diagnosis Epiglottitis typically presents more acutely in young children than in adolescents or adults. | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections Part 13 Clinical Manifestations and Diagnosis Epiglottitis typically presents more acutely in young children than in adolescents or adults. On presentation most children have had symptoms for 24 h including high fever severe sore throat tachycardia systemic toxicity and in many cases drooling while sitting forward. Symptoms and signs of respiratory obstruction may also be present and may progress rapidly. The somewhat milder illness in adolescents and adults often follows 1-2 days of severe sore throat and is commonly accompanied by dyspnea drooling and stridor. Physical examination of patients with acute epiglottitis may reveal moderate or severe respiratory distress with inspiratory stridor and retractions of the chest wall. These findings diminish as the disease progresses and the patient tires. Conversely oropharyngeal examination reveals injection that is much less severe than would be predicted from the symptoms a finding that should alert the clinician to a cause of symptoms and obstruction that lies beyond the tonsils. The diagnosis is often made on clinical grounds although direct fiberoptic laryngoscopy is frequently performed in a controlled environment . an operating room in order to visualize and culture the typical edematous cherry-red epiglottis and to facilitate placement of an endotracheal tube. Direct visualization in an examination room . with a tongue blade and indirect laryngoscopy is not recommended because of the risk of immediate laryngospasm and complete airway obstruction. Lateral neck radiographs and laboratory tests can assist in the diagnosis but may delay the critical securing of the airway and cause the patient to be moved or repositioned more than is necessary thereby increasing the risk of further airway compromise. Neck radiographs typically reveal an enlarged edematous epiglottis the thumbprint sign Fig. 31-2 usually with a dilated .
