Epiglottitis

Definition

Epiglottitis is inflammation of the cartilage that covers the trachea (windpipe).

See also: Croup

Alternative Names

Causes

Epiglottitis is a life-threatening disease. The epiglottis is the piece of cartilage at the back of the tongue that closes off the windpipe when swallowing. Without an epiglottis, food could enter the airways, and you would cough or choke after swallowing. Epiglottitis causes swelling of the epiglottis. Breathing problems increases rapidly as the epiglottis swells. Epiglottitis can get rapidly worse.

Inflammation of the epiglottis is usually caused by the bacteria Haemophilus influenzae (H. influenzae), although it may be caused by other bacteria or viruses. Upper respiratory infections can lead to epiglottitis. Medicines or diseases that weaken the immune system can make adults more prone to epiglottitis.

Epiglottitis is most common in children between 2 and 6 years old. Rarely, epiglottitis can occur in adults, and it may be easily overlooked in such patients.

The occurrence of epiglotti has decreased steadily in the United States since the H. influenzae type B (Hib) vaccine became a routine childhood immunization in the late 1980s.

Symptoms

• Drooling
• Difficulty swallowing
• Difficulty breathing (patient may need to sit upright and lean slightly forward to breathe)
• Noisy breathing (stridor)
• Voice changes (hoarseness)
• Chills, shaking
• Cyanosis (blue skin coloring)

Exams and Tests

Epiglottitis is a medical emergency. Seek immediate medical help. Do not use a tongue depressor (tongue blade) to try to examine the throat at home, as this may make the condition worse.

The health care provider will examine the larynx (voice box) using either a small mirror held against the back of the throat or a viewing tube called a laryngoscope. This procedure, called laryngoscopy, may show a swollen and red epiglottis. Anesthesia may be needed to do a laryngoscopy if a breathing tube is necessary.

Tests used to diagnose epiglottitis may include:

• Blood culture or throat culture -- may show H. influenzae or other bacteria
• CBC -- may show a high number of white blood cells
• Neck x-rays -- may show a swollen epiglottis

Treatment

The patient will be admitted to the hospital, usually an intensive care unit (ICU).

Treatment may include methods to help the patient breathe, including:

• Humidified oxygen (oxygen that has been moistened)
• Breathing tube ( intubation)

Other treatments may include:

• Fluids given by IV
• Antibiotics to treat the infection
• Corticosteroids to decrease the swelling of the throat

Outlook (Prognosis)

Epiglottitis can be a life-threatening emergency. However, with proper treatment, the outcome is usually good.

Possible Complications

Spasm may cause the airway to close abruptly. In this case, death follows within minutes.

The airway may become totally blocked, which could result in death.

When to Contact a Medical Professional

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.