Swelling can also result from an injury. Epiglottitis is sometimes known as supraglottitis.
The epiglottis is the flap at the base of the tongue. It stops food from going down the wrong way into the windpipe (trachea) when eating.
Why is epiglottitis so serious?
The location of the epiglottis is crucial for breathing. If it becomes swollen, it can cause serious airway difficulties. Because of this, it is treated as a medical emergency.
The eipglottis plays a key role in both digestion and breathing.
Sometimes, a swollen epiglottis can completely close off the windpipe and the patient cannot breathe. This is known as respiratory obstruction, and it may completely block the airway.
Immediate medical attention is necessary, because the symptoms can worsen quickly, and the patient can die within hours.
Epiglottitis used to be common among young children, before the introduction of the hemophilus influenzae type B vaccine (Hib) vaccine. Now there are far fewer cases of this type, but they do occur.
Children under 12 months of age, who have not yet completed the three immunizations for Hib, are still susceptible. Similar inflammations, caused by other bacteria, can also lead to epiglottitis.
According to the Centers for Disease Control and Prevention (CDC), an average of 2,562 infections are reported annually, from all age groups.
George Washington is thought to have died of epiglottitis.
What are the symptoms of epiglottitis?
A person with epiglottitis is likely to have signs of:
- Pain and difficulty when swallowing
- A hoarse or muffled voice
- Stridor, a high pitched sound when a person breathes, especially when inhaling
- Severe sore throat
- Cyanosis, when the skin looks blue because the patient is not getting enough oxygen.
A child with epiglottitis will look extremely ill. They may have trouble making eye contact, and be unable to recognize their parents.
The child may try to find a position that enables them to breathe more easily, sitting up rather than lying down, hyperextending the neck and pushing the jaw forward.
What causes epiglottitis?
Epiglottitis can happen for a number of reasons. Here are some of them:
- Hemophilus influenzae type b (Hib) bacterial infection, which can cause epiglottitis, meningitis and pneumonia
- Other bacteria, such as streptococcus pneumoniae, the kind that commonly cause pneumonia
- Fungi, especially in individuals with a weakened immune systems are weak
- A burn injury, after swallowing a very hot drink, or inhaling smoke or steam can cause swelling, as can a blow to the neck
- Crack cocaine users may develop epiglottitis when the inhaled drug or the smoke that comes from it come into contact with the epiglottis and surrounding tissues
These can all cause a swelling of the epiglottis, and the associated risk of breathing problems.
How is epiglottitis diagnosed?
Before diagnosing epiglottitis, a health professional will secure the airway. If there is a possibility that a patient may have epiglottitis, they will be given oxygen.
A flexible laryngoscope, a long, thin flexible tube with a camera at the end may be used to diagnose the condition. The device is inserted into the patient's mouth and down the throat, possibly with a local anesthetic to relieve the discomfort.
The following tests may be carried out:
- A blood test, to determine whether an infection is causing the swelling, and, if so, what type
- A throat swab, to test the mucus on the epiglottis
- A biopsy, which is a sample of epiglottis tissue, to test for infection
- An X-ray or CT scan.
Treatment will depend on the results of the diagnosis.
What is the treatment for epiglottitis?
A person with a diagnosis of epiglottitis will be admitted to the hospital immediately.
Treatment for epiglottitis includes oxygen.
The medical team will secure the airway, and make sure the patient is getting enough oxygen, starting with an oxygen mask.
If an oxygen mask is not enough, tracheal intubation may be needed. The doctor will insert a tube into the patients mouth, or sometimes the nose. The tube goes past the epiglottis and into the windpipe, taking oxygen to the patient's lungs.
In very serious cases, a tracheostomy may be necessary. Surgeons will perform an operation to place a breathing tube directly through the patient's neck and into the windpipe, bypassing the epiglottis.
The physician will give an injection of broad spectrum antibiotics, because even if the condition is due to heat or chemical exposure, there is still a risk of infection.
When the diagnostic tests have shown exactly what kind of infection the person has, more targeted medications can be given.
What are the complications of epiglottitis?
The most dangerous complication is the inability to breathe, which is life-threatening.
If there is an infection, it can spread. Otitis media, or inner ear infection, pneumonia, meningitis or pericarditis, an infection of the lining of the heart, can develop.
How is epiglottitis prevented?
Hib is a major risk factor for epiglottitis. Between 50 percent and 65 percent of infections lead to meningitis, and 17 percent lead to epiglottis.
The incidence of epiglottitis has decreased dramatically since the Hib vaccine became routine for children.
One study suggests that only one child was identified with Hib epiglottitis during the study period from 1997 to 2012, compared 24 children in a comparable 1975 to 1984 study.
This improvement is most likely due to the Hib vaccination.
The best way to prevent epiglottitis is by vaccinating a child against Hib, to protect the child and others in the community.