What Is Epiglottitis?

Epiglottitis is a potentially life-threatening condition in which the epiglottis, a small flap of tissue at the base of the tongue, becomes inflamed and swollen. The epiglottis plays a crucial role in preventing food or liquids from entering the windpipe during swallowing. When it becomes swollen, it can block the airway, making it difficult to breathe and potentially causing respiratory distress. Epiglottitis is most common in children but can also affect adults.

What Causes Epiglottitis?

Epiglottitis is typically caused by bacterial infections, although viruses or other factors may also contribute. The most common causes include:

1. Bacterial Infections

• The most common cause of epiglottitis in children is infection with the bacterium Haemophilus influenzae type b (Hib). In the past, Hib was the leading cause of epiglottitis in children, but widespread vaccination has significantly reduced its incidence.
• Other bacteria that can cause epiglottitis include Streptococcus pneumoniae, Staphylococcus aureus, and group A Streptococcus.

2. Viral Infections

• Although less common, viruses such as herpes simplex virus (HSV), varicella-zoster virus (VZV), and influenza can cause epiglottitis in some cases.

3. Injury or Irritation

• Trauma to the throat, such as swallowing sharp objects, burns, or inhaling chemicals, can also cause inflammation of the epiglottis.
• Smoking or exposure to secondhand smoke may irritate the airway and increase the risk of epiglottitis.

4. Underlying Conditions

• Certain conditions, such as immune deficiencies or diabetes, can make individuals more susceptible to infections, including epiglottitis.

What Are the Symptoms of Epiglottitis?

Epiglottitis often develops rapidly, and the symptoms can progress quickly, requiring immediate medical attention. Common symptoms include:

1. Severe Sore Throat

• The most noticeable symptom of epiglottitis is a severe, often sudden sore throat that makes swallowing painful.

2. Difficulty Breathing

• As the epiglottis swells, it can block the airway, making it difficult for the person to breathe. This may cause labored or noisy breathing, especially during inhalation (stridor).

3. Drooling

• Drooling occurs because the child or adult may have difficulty swallowing their saliva due to the pain and swelling of the epiglottis.

4. Fever

• A high fever is common in those with epiglottitis and may be accompanied by chills.

5. Muffled Voice

• The inflammation of the epiglottis can affect the voice, making it sound muffled or hoarse.

6. Restlessness and Anxiety

• Individuals with epiglottitis may appear anxious or restless due to the difficulty in breathing and discomfort.

7. Swollen Neck

• In some cases, swelling around the neck or under the chin may occur due to the inflammation.

How Is Epiglottitis Diagnosed?

Early diagnosis of epiglottitis is essential to prevent respiratory failure and other complications. Diagnosis typically involves:

1. Physical Examination

• A doctor will perform a physical exam and assess symptoms, such as fever, difficulty swallowing, and breathing patterns. The presence of a muffled voice or stridor often raises suspicion.

2. Imaging Tests

• A lateral neck X-ray may be performed to visualize the epiglottis and check for swelling. The image may show a characteristic “thumbprint sign,” which indicates an enlarged epiglottis.

3. Endoscopy

• In some cases, a flexible tube (laryngoscope) may be used to look at the throat directly. However, this procedure is often avoided in emergency situations because it may worsen breathing difficulties if done improperly.

4. Blood Tests

• Blood tests may be conducted to check for signs of infection, including elevated white blood cell counts, which suggest a bacterial infection.

How Is Epiglottitis Treated?

Epiglottitis is a medical emergency and requires immediate treatment. The goals of treatment are to secure the airway, treat the underlying infection, and prevent complications. Common treatment approaches include:

1. Airway Management

• In severe cases, securing the airway is the top priority. This may require the insertion of a breathing tube (endotracheal tube) or, in some cases, a surgical procedure called a tracheotomy to bypass the blocked airway.
• Oxygen therapy or mechanical ventilation may be required to help the patient breathe while treatment is initiated.

2. Antibiotics

• Epiglottitis caused by bacterial infections is treated with intravenous (IV) antibiotics, often a broad-spectrum antibiotic like ceftriaxone or cefotaxime. Once the specific bacteria are identified, the antibiotics may be adjusted accordingly.
• Corticosteroids may also be administered to reduce swelling and inflammation in the epiglottis and surrounding tissues.

3. Hydration and Supportive Care

• Fluid management through IV fluids helps keep the patient hydrated and supports recovery. Pain medications or fever reducers may be given to manage discomfort.

4. Viral Infections

• If the cause is viral, antiviral medications or other treatments may be recommended, though the primary focus will still be managing airway obstruction and symptoms.

5. Hospitalization

• Epiglottitis requires hospitalization, often in an intensive care unit (ICU) for close monitoring, especially in children.

When Should You See a Doctor About Epiglottitis?

If you suspect that you or someone else may have epiglottitis, seek medical attention immediately. This is a medical emergency, and delayed treatment can lead to severe complications, including suffocation, respiratory failure, or shock. If a person exhibits any of the following, immediate medical care is necessary:

• Difficulty breathing or noisy breathing (stridor)
• Severe sore throat that is not relieved by over-the-counter pain medications
• Drooling and difficulty swallowing
• Muffled or hoarse voice
• Sudden fever with difficulty breathing

How Can You Prevent Epiglottitis?

Prevention of epiglottitis focuses on reducing the risk of infections, especially bacterial infections, and ensuring vaccination. Key preventive measures include:

1. Vaccination

• The Hib vaccine has significantly reduced the incidence of epiglottitis caused by Haemophilus influenzae type b. Vaccination is recommended for all children, starting at two months of age.
• Adults who are at higher risk (such as healthcare workers) may also benefit from Hib vaccination.

2. Good Hygiene Practices

• Washing hands frequently and avoiding close contact with individuals who have respiratory infections can reduce the risk of infections that may lead to epiglottitis.

3. Avoiding Exposure to Smoke

• Exposure to tobacco smoke can irritate the airways and increase susceptibility to infections that may lead to conditions like epiglottitis.