Epiglottitis

What Is epiglottitis?

The epiglottis is the flap of tissue located just above the windpipe (trachea) that directs the flow of air and food in the throat. When we breathe, the epiglottis moves to allow air into the lungs. When we eat, the epiglottis covers the top of the windpipe, so that food goes into the swallowing tube (esophagus), and not into the lungs.

Epiglottitis (inflammation of the epiglottis) can occur at any age and is usually due to a bacterial infection such as Haemophilus influenzae or Streptococcus pneumoniae. More rarely, epiglottitis can be caused by noninfectious conditions such as smoke inhalation or autoimmune disease.

Until 1985, epiglottitis occurred most commonly in children ages 3 to 7, but with the development of a vaccine against Haemophilus influenzae type b (Hib), epiglottitis is now increasingly rare in vaccinated children, but when it occurs it is potentially life-threatening. It causes sudden swelling of the epiglottis, which often worsens rapidly, sometimes within hours. Without timely treatment, the epiglottis can become so large that it blocks the windpipe, impairing breathing.

Symptoms of epiglottitis

The most common signs and symptoms of epiglottitis include:

• severe sore throat that comes on suddenly
• fever
• shortness of breath or difficulty breathing, especially when lying down
• drooling and difficulty managing saliva in the mouth
• a loud, high-pitched sound heard when breathing in (called stridor), often heard along with a "barking" cough
• difficulty swallowing
• muffled voice
• preference for sitting upright with neck extended and face tilted slightly upward in a "sniffing" position to be able to breathe.

Diagnosing epiglottitis

Epiglottitis is an emergency. If you think your child has this infection, seek emergency help immediately. Never try to look down the throat of a person who is suspected of having epiglottitis. Pressing on the tongue to look down the throat may cause the epiglottis to swell even more and further block the airway.

X-rays of the neck sometimes can show an enlarged epiglottis, but the time needed to take the x-rays may delay other important tests and treatment.

After doctors in the hospital confirm that the epiglottis is inflamed, they may recommend that the airway be kept open by placing a breathing tube in the throat. Blood tests and/or throat swabs can help determine which organism is causing the infection.

Expected duration of epiglottitis

Most people begin to recover within 24 to 48 hours after receiving antibiotics. If a breathing tube is needed, it can usually can be removed soon after antibiotics begin. It may take up to a week or more to recover completely.

Preventing epiglottitis

Most cases of epiglottitis in children can be prevented by having children vaccinated against Hib and pneumococcal infections.

Treating epiglottitis

Epiglottitis needs to be treated in the hospital (usually in an intensive care unit) so the person's breathing can be closely monitored. If the person is having trouble breathing, he or she may need to have a breathing tube inserted in his or her throat. Health care providers with experience and skill in the treatment of diseases of the airway should be involved early in caring for someone with epiglottitis. This may include an intensive care doctor, anesthesiologist, or otolaryngologist. Antibiotics should be started as soon as possible, though preferably after blood samples and throat swabs are taken. Antibiotics usually are given intravenously (into a vein). Once the infection is under control, antibiotics can be taken by mouth until treatment is complete. Additional medicines may be given to control fever and pain.

When to call a professional

Call an ambulance at the first sign of unexplained breathing difficulty, especially if accompanied by a sore throat, fever, drooling, or noisy breathing.

Prognosis

With proper treatment, people usually recover completely. The key, however, is recognizing the symptoms early, so that treatment can be started before the condition worsens.

Additional info

American Academy of Pediatrics (AAP)
https://www.aap.org/

American Academy of Otolaryngology–Head and Neck Surgery
https://www.entnet.org/