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 PDT

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Epiglottitis is inflammation (swelling) of the epiglottis - a flap located at the base of the tongue which stops food from going down the wrong way into the windpipe (trachea) when we are eating. As the epiglottis sits in a crucial place for proper breathing, if it becomes swollen it can cause serious breathing difficulties and is treated as a medical emergency. In some cases, epiglottitis can completely close off the windpipe and the patient cannot breathe, known as respiratory failure.

If left untreated, epiglottitis symptoms can worsen quickly and the patient can die within a matter of hours.

Since the introduction of the Hib vaccine (Haemophilus influenzae type B vaccine), the number of epiglottitis cases has dropped dramatically. Epiglottitis used to be a widespread infection among young children before the Hib vaccine. As bacteria other than type b Hib can cause a similar inflammation, cases of epiglottitis still exist. In the UK there is 1 case in every 200,000 children and 1 in every 100,000 adults each year now.

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.

George Washington is thought to have died of epiglottitis.

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.

An affected patient, often a child in some developing nations that don't have widespread Hib vaccinations, may experience:

• Fever
• Swallowing difficulties, often painful
• Drooling
• A hoarse or muffled voice
• Stridor - a high pitched sound that accompanies respiration, especially when breathing in
• Severe sore throat
• Cyanosis - skin may take on a blue tinge if the patient is not getting enough oxygen

The World Health Organization says that children will look extremely ill and do not want to lie down (prefer sitting up on their beds).

What causes epiglottitis?

• Hib bacteria (Haemophilus influenzae type b) - infection can cause epiglottitis as well as meningitis and pneumonia. Since widespread vaccinations, incidence of epiglottitis has dropped dramatically.
• Other bacteria - such as the one that commonly causes pneumonia - streptococcus pneumoniae.
• Fungi - especially individuals whose immune systems are weak.
• Chickenpox.
• An injury - if you swallow a very hot drink too quickly there is a risk that the epiglottis will swell.
Other injuries, caused by a blow to the neck may also cause epiglottitis.

Crack cocaine - crack cocaine users are more likely to experience sub-acute epiglottitis symptoms.

How is epiglottitis diagnosed?

The medical team will focus on making sure the patient has an adequate supply of oxygen if epiglottitis is suspected, before any diagnostic tests are considered.

Laryngoscopy, and nowadays mostly of the fiber-optic kind will be used to confirm diagnosis. This is a long, thin flexible tube with a camera at the end which is inserted into the patient's mouth and down his/her throat. The doctor must be prepared for possible airway spasm caused by inserting something into the throat. In order to relieve any discomfort, a local anesthetic may be ordered.

Blood test - this may help the doctor determine whether an infection may be the cause, and what type.

Throat culture (swab) - some of the mucus on the epiglottis may be swabbed with some cotton, and then examined.

Biopsy - a sample of epiglottis tissue is taken and tested for infection.

Imaging scans - the doctor may order an x-ray or CT scan.

What is the treatment for epiglottitis?

Epiglottitis is a medical emergency and requires immediate hospitalization. The medical team need to secure the airways - make sure the patient is getting enough oxygen. Sometimes an oxygen mask is enough.

Tracheal intubation - if an oxygen mask is not enough, the doctor will insert a tube into the patients mouth (sometimes the nose), past the epiglottis and into the windpipe - oxygen enters the patient's lungs through the tube. In very serious cases a hole will be bored into the patient's neck, through the skin, and the tube will go into the windpipe through this hole, bypassing the epiglottis.

Antibiotics - injections of broad spectrum antibiotics are given to the patient; but only after the airways have been secured. As soon as the diagnostic tests determine the exact nature of the infection, more targeted medications can be administered.

What are the complications of epigliottitis?

The most dangerous complication is respiratory failure (the patient cannot breathe properly, and sometimes not at all) - this is a life-threatening condition.

An infection can spread and otitis media (inner ear infection), meningitis, pericarditis (heart lining infection) and pneumonia can develop.

How is epiglottitis prevented?

Vaccinating a child against Hib is the best way of protecting him/her and other people in a community.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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