Epiglottitis

Definition

Epiglottitis is inflammation of the tissue that covers the trachea (windpipe). It is a life-threatening disease.

See also: Croup

Alternative Names

Supraglottitis

Causes, incidence, and risk factors

The epiglottis is a piece of stiff, yet flexible tissue (called cartilage) at the back of the tongue. It closes your windpipe (trachea) when you swallow so food does not enter your airways. This helps prevent coughing or choking after swallowing.

Swelling of the epiglottis is usually caused by the bacteria Haemophilus influenzae (H. influenzae). It may also be caused by other bacteria or viruses related to upper respiratory infections.

Epiglottitis is now very uncommon, because the H. influenzae type B (Hib) vaccine is a routine childhood immunization. The disease was once most often seen in children ages 2 - 6. Rarely, epiglottitis can occur in adults.

Symptoms

Epiglottitis begins with a high fever and sore throat. Other symptoms may include:

• Abnormal breathing sounds (stridor)
• Chills, shaking
• Cyanosis (blue skin coloring)
• Drooling
• Difficulty breathing (patient may need to sit upright and lean slightly forward to breathe)
• Difficulty swallowing
• Voice changes (hoarseness)

Signs and tests

Epiglottitis is a medical emergency. Seek immediate medical help. Do not use a tongue depressor (tongue blade) to try to examine the throat at home, as this may make the condition worse.

The health care provider may examine the voice box (larynx) using either a small mirror held against the back of the throat or a viewing tube called a laryngoscope.

Tests that may be done include:

• Blood culture or throat culture
• Complete blood count (CBC)
• Neck x-ray

Treatment

A hospital stay is needed, usually in the intensive care unit (ICU).

Treatment involves methods to help the person breathe, including:

• Breathing tube (intubation)
• Moistened (humidified) oxygen

Other treatments may include:

• Antibiotics to treat the infection
• Anti-inflammatory medicines called corticosteroids to decrease throat swelling
• Fluids given through a vein (by IV)

Support Groups

Expectations (prognosis)

Epiglottitis can be a life-threatening emergency. However, with proper treatment, the outcome is usually good.

Complications

Spasm may cause the airways to close abruptly. In this case, death follows within minutes.

The airways may become totally blocked, which could result in death.

Calling your health care provider

Call the local emergency number (such as 911) if your child has symptoms of epiglottitis, including sudden breathing difficulties, excessive drooling, and irritability.

Prevention

Immunization with the Hib vaccine protects most children from epiglottitis.

The bacteria that causes epiglottitis is contagious. If someone in your family is sick from this bacteria, you need to be tested and treated appropriately.

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References

Manno M. Pediatric respiratory emergencies: Upper airway obstruction and infections. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 166.

Burns JE, Hendley JO. Epiglottitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 59.