What is epiglottitis?
Another name for epiglottitis is supraglottitis, but supraglottitis also involves inflammation of the cartilage that is near the voice box.
The epiglottis is the cartilage flap at the base of the tongue. When a person swallows, the epiglottis stops solid food and liquids from going down through the voice box and windpipe to the lungs.
Why is epiglottitis serious?
A very sore throat is one possible symptom of epiglottitis, but it can also lead to breathing difficulties, which can be life-threatening.
The location of the epiglottis means that if it swells, it can block the airway. This can cause serious breathing difficulties. For this reason, epiglottitis is a medical emergency.
Sometimes, severe epiglottitis can cause the windpipe to close completely so that the person cannot breathe.
If this happens, the person will need immediate medical attention. The symptoms can worsen quickly, sometimes becoming fatal 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 epiglottitis, but they do occur.
Children who have not yet completed the recommended series of vaccinations for Hib are at risk for Hib infections, including epiglottitis. Infection caused by other bacteria or viruses can also lead to epiglottitis.
According to the Centers for Disease Control and Prevention (CDC), an average of 2,562 Hib infections occurred every year in the United States from 2003 to 2010, from all age groups.
A person with epiglottitis may have signs of:
- pain and difficulty when swallowing
- a hoarse or muffled voice
- stridor, a high pitched sound when breathing, especially when inhaling
- a severely sore throat
- cyanosis, when the skin looks blue because not enough oxygen is reaching the bloodstream
Typically, a child with epiglottitis will look extremely ill. They may have trouble making eye contact and be unable to recognize their parents or carers.
The child may try to find a position that enables them to breathe more easily, such as sitting up rather than lying down. They may extend their neck and push the jaw forward.
Epiglottitis can happen for many reasons, including:
- Hib, which is a bacterial infection that can cause epiglottitis, meningitis, and pneumonia.
- Other bacteria, such as Streptococcus pneumoniae (S. pneumoniae), which commonly causes pneumonia, and group A Streptococcus, which causes strep throat.
- Fungi, especially in individuals with a weakened immune system.
- Varicella zoster virus, which causes chickenpox.
- A burn injury after swallowing a very hot drink, or inhaling smoke or steam can cause epiglottis inflammation, as can a blow to the neck.
- Crack cocaine when the inhaled drug's smoke comes into contact with the epiglottis and surrounding tissues.
These can all cause inflammation, swelling of the epiglottis, and a risk of breathing problems.
A doctor will examine the person's throat. They may also need to use a laryngoscope, a tube with a camera on the end, to get a better picture.
Before diagnosing epiglottitis, a health professional will secure the airway. This means they make sure the person can breathe, for example, by providing oxygen.
To find out the cause of the problem, the doctor may insert a flexible laryngoscope, which is a long, thin flexible tube with a camera at the end, into the person's mouth, and down their throat.
They may use a local anesthetic to relieve the discomfort.
They may also order the following tests:
- a blood test, to see if an infection is causing the swelling and, if so, what type
- a throat culture swab, to test the mucus on the epiglottis
- a biopsy, which involves taking a sample of epiglottis tissue to check for abnormal cell features
- an X-ray or CT scan of the neck
Treatment depends on the results of the diagnosis.
A person with a diagnosis of epiglottitis must go to the hospital immediately.
The medical team will secure the person's airway, starting with an oxygen mask to make sure they are getting enough oxygen.
If an oxygen mask is not sufficient, the doctor may need to insert a tube to take oxygen to the lungs. The doctor will insert the tube into the person's mouth, or sometimes the nose. The tube goes past the epiglottis and into the windpipe.
In severe cases, the person may need a tracheostomy or cricothyroidotomy. This is a procedure in which a surgeon places a breathing tube directly through the person's neck and into their windpipe, bypassing the epiglottis.
The doctor will give an injection of broad-spectrum antibiotics. Even if the condition is due to heat or chemical exposure, a person is still at risk of developing a bacterial infection.
If the tests show exactly what kind of infection the person has, the doctor will prescribe more targeted medications.
The most dangerous complication is the inability to breathe, which is life-threatening.
If there is an infection, it might cause other conditions, such as otitis media, also called middle ear infection, pneumonia, meningitis, or pericarditis, which is inflammation of the lining around the heart.
Since children started having the Hib vaccine as a routine measure, the number of cases of epiglottitis has fallen dramatically.
Hib is a significant risk factor for epiglottitis. According to the Immunization Action Coalition, 50–65 percent of infections lead to meningitis, and 17 percent lead to epiglottitis.
According to the CDC, the number of cases of invasive Hib disease in the U.S. started to fall dramatically in the late 1980s, around the time Hib vaccines became routine for children.
Since a vaccination has been readily available, the incidence of epiglottitis has fallen by more than 99 percent.
This improvement shows the effectiveness of the Hib vaccination.
Epiglottitis is a severe condition that occurs when inflammation causes the epiglottis to swell up. One of the leading causes is an infection, but other conditions can cause it, too.
There is a risk that the person may become unable to breathe. If this happens, it can be fatal. For this reason, a person who has or suspects they may have epiglottitis needs immediate medical attention.
The best way to prevent epiglottitis due to Hib is by vaccinating a child against Hib. The vaccination will protect the child and others in the community.