Epiglottitis

Answer 1

Definition

Epiglottitis is inflammation of the cartilage that covers the trachea (windpipe).

See also: Croup

Alternative Names

Supraglottitis

Causes, incidence, and risk factors

Epiglottitis is a life-threatening disease. The epiglottis is a piece of cartilage at the back of the tongue. Its job is to close off the windpipe when swallowing. It keeps food from entering the airways, so you don't cough or choke after swallowing.

Epiglottitis is swelling of the epiglottis, which may block the windpipe and lead to breathing problems. Swelling of the epiglottis is usually caused by the bacteria Haemophilus influenzae (H. influenzae), although it may also be caused by other bacteria or viruses that lead to upper respiratory infections.

Epiglottitis is now very uncommon, but it was most common in children ages 2 - 6. Rarely, epiglottitis can occur in adults, and it may be easily overlooked in such patients.

The occurrence of epiglottitis has decreased dramatically in the United States since the H. influenzae type B (Hib) vaccine became a routine childhood immunization in the late 1980s.

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 will examine the voice box (larynx) using either a small mirror held against the back of the throat or a viewing tube called a laryngoscope. (See: laryngoscopy) The exam may show a swollen and red epiglottis.

Tests used to diagnose epiglottitis may include:

• Blood cultureor throat culture-- may show H. influenzae or other bacteria
• Complete blood count (CBC) -- may show a high number of white blood cells
• Neck x-rays -- may show a swollen epiglottis

Treatment

The patient will be admitted to the hospital, usually an intensive care unit (ICU).

Treatment may include methods to help the patient 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)

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 children from epiglottitis.

The bacterial infection that causes epiglottitis is contagious, so family members should be screened and treated if appropriate.

References

Sobol SE. Epiglottitis and croup. Otolaryngol Clin North Am. 2008;41(3):551-566.

Alcaide ML. Pharyngitis and epiglottitis. Infect Dis Clin North Am. 2007;21(2):449-469.

Answer 2

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.

This examination is best done in the operating room or a similar setting where sudden breathing problems can be more easily handled.

Tests that may be done include:

• Blood cultureor 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)

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.

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.

Reviewed By

Review Date: 02/02/2012

John Goldenring, MD, MPH, JD, Pediatrics, Sharp Rees-Stealy Medical Group, San Diego, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.