• Objective: To compare the initial clinical manifestations and sequelae of epiglottitis among children and adult residents of Olmsted County, Minnesota. • Material and Methods: We conducted a population-based retrospective cohort study of all Olmsted County residents with the diagnosis of epiglottitis during the 15-year period from Jan. 1,1976, through Dec. 31,1990. • Results: From 1976 through 1990, 41 residents (20 children and 21 adults) of Olmsted County were diagnosed with epiglottitis. (One case in an adult was first diagnosed at autopsy and was included only in the incidence rates and analysis of seasonal and secular trends.) Children had a mean annual incidence rate of 4.25 per 100,000, whereas the rate in adults was 2.18 per 100,000. The age- and sex-adjusted incidence of epiglottitis decreased during the study period from 4.94 per 100,000 during 1976 through 1980 to 2.08 per 100,000 during 1986 through 1990. No seasonal effect was detected in adults or children. At initial assessment, adults tended to have pharyngeal symptoms (sore throat and odynophagia), cervical adenopathy, and ear pain, whereas children most often had respiratory (stridor, dyspnea, and retractions) and laryngeal symptoms. Proportionately, more children than adults received artificial airway support and had associated pneumonia. One death occurred in an adult, in whom the diagnosis was made at autopsy. • Conclusion: The incidence of epiglottitis has decreased significantly in recent years. Children and adults have considerably different initial manifestations of epiglottitis.
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