Epiglottitis physical examination

A definitive diagnosis of acute epiglottitis can be confirmed by direct inspection under laryngoscopy, although this may provoke airway obstruction. The epiglottis and the surrounding structures appear erythematous and swollen. Physical examination may include:^[1][2][3] tenderness of anterior neck, high temperature, increased respiratory rate in both children and adults, pharyngeal redness and cervical lymphadenopathy. In addition, patients with epiglottitis may adapt the so called tripod posture with hyper-extension of the neck, chin pointing forward and trunk and arms leaning forward.^[4]

Physical examination of patients suspected of having epiglottitis requires inspection of the oropharyngeal and suprapharyngeal area. A definitive diagnosis may be established by direct visualization of an erythematous and swollen epiglottis under laryngoscopy. Because of the risk of provoking airway spasm or obstruction, this procedure should be performed only when skilled personnel and equipment to secure the airway are available.^[5][6]

On physical examination, patients with epiglottitis may present with the following:^[1][2][3][6]

• Patients with epiglottitis especially children may adapt the so called tripod posture with hyper-extension of the neck, chin pointing forward and trunk and arms leaning forward.^[4]
• They are usually acutely-ill looking.

• High temperature

• Inflammed epiglottis
• Pharyngeal redness

• Tenderness of anterior neck
• Cervical lymphadenopathy

• May be in obvious respiratory distress with flaring of ala nasi, subcostal and intercostal recessions.
• Increased respiratory rate in both children and adults
• Decreased air-entry depending of degree of airway obstruction

• Cyanosis

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