Epiglottitis

Overview

Epiglottitis is a medical emergency in which the epiglottis, a small cartilage "lid" that covers the windpipe, swells. This swelling blocks the flow of air into the lungs and can be deadly if not treated promptly. Epiglottitis can be caused by infections, burns from hot liquids, or injuries to the throat. It can occur at any age, although it was once more common in children due to Hib infections. Routine Hib vaccination for infants has significantly reduced the incidence of epiglottitis in children. The condition now affects adults more often. Symptoms include fever, sore throat, difficulty swallowing, and a high-pitched sound when breathing in (stridor). Epiglottitis requires immediate medical attention, and if you or someone you know experiences difficulty breathing and swallowing, seek emergency medical care.

Understanding the disease

Symptoms

Symptoms of epiglottitis can vary depending on the age of the affected individual. In children, symptoms may appear within hours and may include fever, sore throat, unusual high-pitched sound when breathing in (stridor), difficulty and painful swallowing, drooling, and acting anxious and irritable. In adults, symptoms may take days to develop and may include fever, sore throat, a muffled or hoarse voice, unusual high-pitched sound when breathing in, difficulty breathing, difficulty swallowing, and drooling. If you or someone you know experiences sudden trouble breathing and swallowing, it's a medical emergency and you should call your local emergency number or go to the nearest hospital emergency department.

Risk Factors

Risk factors for developing epiglottitis include having a weakened immune system, which can be more likely to get bacterial infections that may cause epiglottitis, and not being fully vaccinated. Skipping vaccinations or not getting them on time can leave a child open to Haemophilus influenzae type b (Hib) and increase the risk of epiglottitis.

Assessment and Diagnosis

Triage

If you or someone you know suddenly has trouble breathing and swallowing, you should see a doctor immediately. Epiglottitis is a medical emergency that requires immediate attention. Call your local emergency number or go to the nearest hospital emergency department. Keep the person quiet and upright to make it easier to breathe.

Diagnosis

To diagnose epiglottitis, a healthcare provider will first ensure that the airway is open and that enough oxygen is getting through. They will monitor breathing and blood oxygen levels. If necessary, breathing aid might be provided using an oxygen mask or intubation. Once breathing is stable, tests are conducted to diagnose epiglottitis, such as a throat exam using a flexible fiber-optic-lighted tube, a chest or neck X-ray, and throat culture and blood tests. A healthcare provider will wipe the epiglottis with a cotton swab and check the tissue sample for Hib. Blood cultures can determine whether there's an infection of the blood known as bacteremia, which is often present with epiglottitis.

Management and Treatment

Complications

Epiglottitis can result in several potential complications. One of the most severe complications is asphyxiation, which occurs when the epiglottis swells so much that it blocks the airway, preventing breathing. Other potential complications include:

1. Respiratory failure: Due to the airway blockage, the lungs may not receive enough oxygen, leading to respiratory failure.
2. Blood infection (sepsis): The infection can spread through the bloodstream, causing sepsis, a life-threatening condition.
3. Permanent brain damage: If oxygen deprivation persists for an extended period, it can lead to permanent brain damage.
4. Death: In severe cases, epiglottitis can be fatal if not treated promptly. It's important to seek immediate medical attention if you suspect epiglottitis, as timely intervention can prevent potential complications and ensure a better outcome.

Prevention

epiglottitis can be prevented through vaccination and proper hygiene practices. In the United States, the Hib vaccine is given to infants to prevent epiglottitis caused by Haemophilus influenzae type b (Hib) bacteria. The vaccine is typically administered in three or four doses: at 2 months, 4 months, and between 6-18 months of age. Additionally, practicing good hygiene can help prevent the spread of infections that may lead to epiglottitis. This includes regular handwashing, covering the mouth and nose when coughing or sneezing, and avoiding close contact with individuals who have contagious infections. It's important to note that in rare cases, epiglottitis can be caused by physical injury, hot liquid burns, or breathing in smoke from a fire. Taking appropriate safety precautions can help reduce the risk of such injuries. Finally, maintaining a healthy immune system and staying up-to-date with vaccinations can also lower the risk of contracting infections that may lead to epiglottitis.

Treatment

Treating epiglottitis involves addressing both the breathing difficulties and the underlying infection. Initial steps focus on ensuring proper breathing, which may include wearing an oxygen mask or having a breathing tube placed through the nose or mouth. In some rare cases, a healthcare provider may perform a needle cricothyroidotomy to create an emergency airway. Once breathing is stable, antibiotics are given through a vein to treat the infection. Initially, a broad-spectrum antibiotic may be prescribed, followed by a more-targeted medication based on the specific bacterial cause of the epiglottitis. Throat cultures and blood tests may also be performed for diagnosis and to guide treatment decisions. Remember that epiglottitis is a medical emergency, so it is crucial to seek immediate medical attention if you or your child experiences symptoms.

Preparing for medical consultation

To prepare for an appointment for epiglottitis, follow these steps:

1. Observe and document symptoms: Write down any symptoms you're experiencing, including difficulty swallowing, sore throat, fever, and any other symptoms that may be related to epiglottitis. Note when the symptoms began and if they worsen at specific times.
2. Gather medical history: Make a list of your key medical information, such as any existing conditions, previous infections, or surgeries. Include a list of all medications, vitamins, and supplements you're taking, including doses.
3. Prepare for any necessary tests: Ask your doctor if there are any tests you need to have before the appointment. For example, you may need blood tests, imaging studies like an X-ray or CT scan, or an examination of your throat with a specialized scope.
4. Bring a list of questions: Compile a list of questions to ask your doctor during the appointment. Some questions to consider include the cause of your symptoms, the most appropriate treatment options, and what steps you can take to prevent future occurrences of epiglottitis.
5. Seek support: Consider having a family member or friend accompany you to the appointment, as they may remember important details or provide emotional support during the appointment. Remember to be proactive in communicating with your doctor and asking questions to ensure you receive the most accurate and relevant information regarding your condition.