Synopsis
Recognise impending upper-airway obstruction, avoid destabilising examination, secure the airway with senior anaesthetic and ENT expertise, and combine intravenous antimicrobials with drainage of deep collections.
- Airway safety comes before diagnostic certainty; keep a distressed patient upright and avoid procedures that may precipitate obstruction.
- Adult epiglottitis often presents with severe throat pain, dysphagia, muffled voice and minimal oropharyngeal findings; stridor is a late warning.
- Deep-neck infection follows tonsillar, dental, salivary, traumatic or instrument-related infection and may spread between fascial planes into the mediastinum.
Key red flags
Stridor, drooling, inability to swallow secretions or exhaustion indicates critical airway narrowing requiring immediate expert control.
Severe odynophagia, drooling, quiet muffled speech and preference to sit forward with little visible pharyngeal inflammation is a high-risk pattern.
Investigation priorities
Detect deterioration before complete obstruction.
Management branches
Upper-airway infection is suspected from pain, voice, swallowing or neck findings.
- Keep the patient upright, calm and nil by mouth while experienced anaesthesia and ENT attend with difficult-airway equipment.
- Avoid tongue depression, unnecessary cannulation attempts and unmonitored transfer when obstruction is plausible.
Key medicines
Ceftriaxone for severe epiglottic infectionGive ceftriaxone 2 g intravenously once daily in adults, using meningitis dosing if central nervous system infection is suspected.
Co-amoxiclav for polymicrobial deep-neck infectionGive co-amoxiclav 1.2 g intravenously every 8 hours for severe odontogenic or polymicrobial deep-neck infection when local guidance supports it.