Epiglottitis is a disorder caused by inflammation of the cartilage that covers the trachea (windpipe). See also croup syndrome .
Causes, incidence, and risk factors
Epiglottitis is most common in children between 2 and 6 years old and is usually caused by the bacterium Haemophilus influenzae , although it may be caused by other bacteria or viruses. The incidence of this disease has decreased steadily since Haemophilus influenzae group b (Hib) vaccine became a routine childhood immunization in the late 1980s. Epiglottitis is a life-threatening disease that begins with a high fever and very sore throat . The epiglottis (the flap of cartilage at the back of the tongue that closes off the windpipe when swallowing) swells and can obstruct breathing. Respiratory distress increases rapidly as the epiglottis swells. Immunosuppression (from medications or diseases that reduce the action of the immune system) can predispose adults to epiglottitis. Swallowing problems may be associated with drooling . Difficulty breathing may cause the patient to sit up, leaning slightly forward and looking very anxious. Spasm may cause the airway to close abruptly. Death follows within minutes . Do not make any attempts to look into the patient's mouth if epiglottitis is suspected. Immediate emergency medical help is imperative! EPIGLOTTITIS IS A MEDICAL EMERGENCY.
Signs and tests
Do not attempt to examine the throat (larynx) at home, because use of the tongue blade may cause the condition to worsen. The health care provider will examine the larynx ( laryngoscopy ) and may find an enlarged, reddened epiglottis. Anesthesia may be required for laryngoscopy in a patient with epiglottitis, in the event insertion of a breathing tube (intubation) becomes necessary to maintain the airway.
Stridor may be present. Blood culture or throat culture may show H. influenzae or other bacteria.
A CBC may show an elevated WBC count .
Neck X-rays may show enlargement of the epiglottis.
Treatment
Hospitalization is required because this is an emergency situation. The patient is usually admitted to the intensive care unit.
Treatment usually involves the administration of humidified oxygen, which is oxygen that has been moistened to help the patient breathe. The patient will probably be intubated, meaning a tube is passed through the nose or mouth into the trachea to help the patient breathe. Intravenous fluids are given to increase hydration. Antibiotics are used to treat the infection. Corticosteroids may be used to decrease the swelling of the throat.
Expectations (prognosis)
Epiglottitis can be a life-threatening emergency. However, with proper treatment, the outcome is usually good.
Complications
The airway may become totally obstructed, which could result in death.
Calling your health care provider
Go immediately to the emergency room or call the local emergency number (such as 911) if your child has symptoms suggestive of epiglottitis, including rapid onset of breathing difficulties , excessive drooling, and irritability.
Prevention
The bacterial infection that causes epiglottitis is contagious, so family members should be screened and treated if appropriate. Have your children immunized with the Hib vaccine.