What is epiglottitis?
Epiglottitis is inflammation and swelling of the epiglottis, the thin cartilage structure at the root of the tongue that closes off the windpipe (trachea) when foods or liquids are being swallowed.
Who is affected by epiglottitis?
Epiglottitis can affect people of any age. It affects males more than females at a rate of 2.5 to 1.
Before the widespread use of Hib vaccinations in 1985, the disease was seen mainly in children between 3 and 5 years of age. By the year 2000, the annual incidence of invasive Hib infection in children younger than 5 years decreased 99 percent to less than 1 case per 100,000.
Symptoms and Causes
What are the symptoms of epiglottitis?
Symptoms usually appear and get worse quickly, although the progression of symptoms in older children and adults may take a few days to fully develop. The most common symptoms are:
- Severe sore throat
- Difficulty and pain when swallowing (a main symptom in older children and adults)
- Difficulty breathing (a main symptom in children), which may be helped by sitting up and leaning forward, or breathing with an open mouth and protruding tongue
- Abnormal or high-pitched breathing noises (a main symptom in children), which is often related to a blockage in the airway
- Hoarse or muffled voice
- Fever of 100.4 F or higher
- Irritability and restlessness
- Drooling (a main symptom in older children and adults)
What causes epiglottitis?
Transmission of the bacteria is the same as with the common cold: Droplets of saliva or mucus are spread into the air when a carrier of the bacteria coughs or sneezes. Another person is infected by breathing in or coming into contact with a surface where the bacteria have landed.
Other possible causes include:
- Bacterial infections from non-Hib sources, such as those from streptococcus pneumonia
- Fungal infections, particularly in people with a weak immune system
- Viral infections from varicella zoster virus (which causes chickenpox) or herpes simplex virus (which causes cold sores)
- Injury to the throat, either through a physical blow or by drinking a very hot liquid
- Smoking, especially marijuana, crack cocaine or other illegal drugs
- Chemical burns
- Side effect of another disease or chemotherapy
Diagnosis and Tests
How is epiglottitis diagnosed?
Tests done to diagnose epiglottitis include the following.
- A laryngoscopy, using a small camera at the end of a flexible tube, is done to examine the throat.
- A swab of the throat is taken to test for bacteria or viruses.
- Blood tests check the white blood cell count (a high count means the immune system is fighting an infection), and to find any bacteria or viruses in the blood.
- An X-ray or CT (computed tomography) scan may be used to determine the level of swelling, and to see if there is a foreign object in the airway.
Since epiglottitis and croup share a number of common symptoms, it is important that testing pinpoint the illness correctly so that the proper treatment may be given. Unlike croup, which appears mainly during the winter months, epiglottitis is no more common during one part of the year than another.
Management and Treatment
How is epiglottitis treated?
Epiglottitis must be treated in the hospital as a medical emergency.
- The first step is to restore the airways to full capacity. An oxygen mask will be used to deliver air to the lungs. If air passages have already been blocked, a tube is placed in the throat and is pushed past the swelling to deliver oxygen into the lungs. In the most severe cases, a tracheostomy (a cut in the front of the windpipe through which a breathing tube is inserted) may be needed to bypass the swelling in the throat.
- Once oxygen delivery to the lungs has been established, a breathing tube may be inserted through the nose and into the windpipe to make breathing more natural.
- Fluid levels are kept up through an intravenous drip (a needle inserted into a vein).
- Antibiotics may be given to fight off bacterial infection.
Can epiglottitis be prevented?
- In children, the best prevention is to ensure all vaccinations are kept up to date. The undeveloped immune systems of children make them more prone to contracting illnesses from Hib bacteria.
- Wash hands frequently, and avoid placing fingers in the eyes, nose and mouth.
- Take necessary precautions around people who are coughing and sneezing.
- Avoid injury to the throat from drinking hot liquids or smoking.
Outlook / Prognosis
What is the outlook/prognosis for patients with epiglottitis?
With quick and correct treatment, most people with epiglottitis recover in about 1 week and can leave the hospital in 5 to 7 days. Fewer than 1 in 100 cases result in death.
When should I see a healthcare provider about epiglottitis?
Epiglottitis can be a life-threatening condition if swelling progresses to the point of closing off air passages to the lungs. If epiglottitis is suspected, call 911.
At no time should a person suspected of having epiglottitis be laid on their back, have anything inside their mouth, or have anyone but a doctor examine their throat. Remaining calm and under control is also important so that additional stress-induced tightening of the throat does not occur.