What Is Epiglottitis? What Causes Epiglottitis?

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Main Category: Ear, Nose and Throat
Also Included In: Infectious Diseases / Bacteria / Viruses;  Pediatrics / Children's Health;  Respiratory / Asthma
Article Date: 02 Nov 2009 - 4:00 PST

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Epiglottitis is a life-threatening condition. It occurs when the epiglottis, which is a small flap of tissue that covers the windpipe (the trachea), swells and blocks the flow of air into the lungs. It should be regarded as a medical emergency. Left untreated, the symptoms of respiratory failure can quickly worsen, sometimes in the space of just a few hours and may result in death.

The epiglottis is located towards the back of the throat underneath the tongue. The main function of the epiglottis is to close over the windpipe to prevent any food from passing down the windpipe and into the lungs.

A number of factors can cause the epiglottis to swell, such as burns from hot liquids, direct injury to the throat, and various infections. The most common cause of epiglottitis is infection with Hemophilus influenzae type b (Hib), the same bacterium that causes pneumonia and meningitis.

In the past, epiglottitis was a widespread infection among children between 2 to 7 years of age. Routine Hib vaccination for infants has made epiglottitis uncommon, but it remains a concern.

According to Medilexicon's medical dictionary, epiglottitis is "Inflammation of the epiglottis, which may cause respiratory obstruction, especially in children; frequently due to infection by Hemophilus influenzae type b."

What are the signs and symptoms of epiglottitis?

A symptom is something the patient reports and feels, while a sign is something other people, including a doctor may detect. For example, a headache may be a symptom, while a rash may be a sign.

Epiglottitis caused by Hib infection usually begins with a fever and severe sore throat.

The symptoms of epiglottitis usually develop quickly within a matter of hours and rapidly worsen. Symptoms include:

• A high temperature (fever) of 38C (100F), or above
• A severe sore throat
• Breathing sounds which are abnormal and high pitched
• Difficulty and pain when swallowing; most children will refuse to eat because of the pain
• Drooling due to severe pain when swallowing
• Harsh, raspy breathing
• Skin and lips become slightly bluish (cyanosis)
• Voice sounds muffled or hoarse

Any situation where a person suddenly develops breathing difficulties should always be regarded as a medical emergency.

Adult epiglottitis usually affects men who are between 50 to 60 years of age. The reasons for this are uncertain. If prompt treatment is provided to assist with a person's breathing, the outlook for epiglottitis is very good and the vast majority of patients make a full recovery within a week. Deaths from epiglottitis are now very rare.

What causes epiglottitis?

The larynx is a frame of cartilage, muscle and mucous membrane that forms the entrance to the windpipe (trachea), which is the tube that connects the mouth and throat to the lungs. The epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering the windpipe.

The epiglottis drops down when swallowing, sealing off the larynx. When not eating or drinking, the epiglottis is slightly lifted so that air can flow freely into the lungs. But if the epiglottis becomes swollen from infection or injury, the airway can narrow and become completely blocked.

Infection The most common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection with Hemophilus influenzae type b (Hib) bacteria. Hib is not the germ that causes the flu, but it can lead to other serious conditions, including respiratory tract infections (pneumonia) and meningitis (infection of the outer membranes of the brain). Children are particularly vulnerable to a Hib infection because they have an underdeveloped immune system.

Hib spreads through infected droplets coughed or sneezed into the air. The infected droplets can also contaminate surfaces and objects. Anyone placing their hand on a contaminated surface or object may develop an infection if they bring their hand near their face or mouth.

Some people may have the Hib in their nose and throat without becoming sick. However, they can potentially spread the bacteria to others.

Due to the success of the Hib vaccination program, Hib-related infections are rare. However, they may occasionally occur as a result of the small number of cases of vaccination failures.

Other bacteria and viruses can also cause inflammation of the epiglottis, including:

• Streptococcus pneumoniae (pneumococcus), a bacterium that causes meningitis, pneumonia, ear infections and blood infection (sepsis).


• Streptococcus A, B and C, a group of bacteria that cause diseases, such as strep throat, pneumonia, blood infections.


• Candida albicans, the fungus responsible for vaginal yeast infections, diaper rash and oral thrush. People with a weakened immune system are most at risk from these types of infection.


• Varicella zoster, the virus responsible for chickenpox and shingles.

Injury A physical injury, such as a direct blow to the throat, can cause epiglottitis, as well as scald burns to the face or burns from drinking very hot liquids.

Symptoms similar to those of epiglottitis may develop in the following situations:

• Swallowing a chemical that burns the throat
• Swallowing a foreign object
• Smoking drugs such as crack cocaine and heroin

What are the risk factors of epiglottitis?

A risk factor is something which raises the likelihood of developing a disease or condition. For example, obesity increases the risk of developing diabetes type 2; therefore, obesity is a risk factor for diabetes.

Children aged 2 to 6 are most susceptible to epiglottitis caused by Hib. Since routine childhood Hib immunizations began in the mid-1980s, the number of children with epiglottitis has dropped radically.

Although difficult to predict, certain factors increase the risk.

• Gender. Epiglottitis affects more males than females.


• Crowded conditions. Hib bacteria spread rapidly when people are in close contact, such as in child care centers, and even in households where one person has been infected (all family members need to be evaluated by a physician).


• Weak immune system. When the immune system has been weakened by illness or medication.

How is epiglottitis diagnosed?

In suspected cases of epiglottitis, the first priority is to ensure that the patient can breathe properly and that the lungs are receiving an adequate supply of oxygen. Any tests that need to be done will only be carried out once proper breathing is restored and the patient's condition is stable.

• Fiber-optic laryngoscopy
  
  A flexible tube with a camera is used to examine the inside of the throat. A local anesthetic can help relieve any discomfort. It is usually only carried out in adults and older children. This is because it may be difficult for younger children to understand why the procedure is being carried out, which could make them very anxious. This, in turn can exacerbate their breathing problems.

Other tests

• Blood tests are taken to check the number of white blood cells (which may indicate the presence of an infection) and to see whether there are any traces of bacteria, or viruses, in the blood.


• A throat culture can be taken in which the epiglottis is wiped with a cotton swab and the tissue sample is checked for Hib.


• Biopsy - a small sample of tissue (biopsy) may also be taken from the epiglottis, and tested to see if any bacteria, or viruses, are present in the tissue.


• Imaging tests - following these tests, if the diagnosis remains inconclusive, imaging studies can be used to study the throat and epiglottis, such as an X-ray, or a computerized tomography (CT) scan.

What is the treatment for epiglottitis?

Epiglottitis is a medical emergency that requires immediate treatment and admission to hospital.

• The airways. The first priority in treating cases of epiglottitis is to ensure that the patient is able to breathe. This is known as securing the airways.
  
  An oxygen mask that delivers highly concentrated oxygen to the lungs is used. If this measure fails, a tube is placed in the mouth and slid past the epiglottis and into the windpipe. The tube is connected to an oxygen supply. If the situation is critical, a needle may be used to puncture an area of skin in the windpipe. This procedure, called a tracheotomy, allows air to get straight into the lungs while bypassing the larynx. The needle is removed as soon as the airway is open.


• Treating the infection. After the airways have been secured, the source of the infection will need to be treated. This is done by giving injections of broad spectrum antibiotics. They are designed to treat a wide range of different bacterial infections. Once the type of infection has been identified, a more specific type of antibiotic may be used.
  
  Most people will require a 7 to 10 day course of antibiotics. As symptoms improve, antibiotic tablets (oral antibiotics) may be given.

What are the complications of epigliottitis?

If emergency treatment is not given quickly, epiglottitis can be a fatal condition as the airways become totally blocked by the swelling. This can lead to respiratory failure which is a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high. Thankfully, deaths as a result of epiglottitis are rare, and occur in less than 1 in a 100 cases.

In some cases, an infection can spread from the epiglottis to nearby parts of the body including the:

• inner ear (otitis media)
• brain (meningitis)
• heart lining (pericarditis)
• lungs (pneumonia)
• blood infection (sepsis)

How is epiglottitis prevented?

Immunization with the Hib vaccine is an effective way to prevent epiglottitis in children younger than age 5. It is essential to make sure that children´s vaccinations are up to date. Children should receive their hemophilus influenzae type b (Hib) as part of the combined DTaP/IPV/Hib vaccination, which also provides protection against diphtheria, polio, tetanus, and whooping cough.

The Hib vaccine is generally not given to children older than age 5 or to adults because they're less likely to develop Hib infection. But the Center for Disease Control and Prevention CDC), USA recommends the vaccine for older children and adults whose immune systems have been weakened by:

• Sickle cell disease
• HIV/AIDS
• Spleen removal
• Chemotherapy
• Immunosuppressant medications which prevent rejection of organ or bone marrow transplants

Vaccine side effects

The most common side effects of the Hib vaccine include redness, warmth or swelling at the injection site, and a fever. Rarely, a serious allergic reaction may cause difficulty breathing, wheezing, hives, weakness, a rapid heartbeat or dizziness within minutes or a few hours after the shot. If there are signs of an allergic reaction to the vaccine, seek medical help immediately.

Precautions

In some cases, immunized children can develop epiglottitis. Also, other germs can cause epiglottitis. Some common-sense precautions are:

• Not sharing personal items.
• Washing hands frequently.
• Using an alcohol-based hand sanitizer if soap and water are not available.

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today