Epiglottitis: Symptoms, Causes, Treatment

What are the symptoms of epiglottitis?

Epiglottitis is a serious condition characterized by inflammation of the epiglottis, which is the flap of tissue at the base of the tongue that keeps food from going into the trachea (windpipe) during swallowing. Symptoms of epiglottitis can develop rapidly and may include:

1. Severe sore throat
2. Difficulty and pain when swallowing
3. Fever
4. Drooling
5. Stridor (high-pitched breathing sound)
6. Rapid breathing
7. Bluish color of the skin (cyanosis)
8. Difficulty breathing
9. Noisy breathing
10. Restlessness or agitation
11. Fatigue or lethargy

These symptoms can progress quickly and may lead to serious complications, such as airway obstruction, if not treated promptly. Epiglottitis requires immediate medical attention, especially in children, as it can be life-threatening.

What are the causes of epiglottitis?

Epiglottitis is a serious condition that occurs when the epiglottis, a small flap of tissue at the back of the throat that covers the windpipe during swallowing, becomes inflamed and swollen. This can block the flow of air into your lungs. The main cause of epiglottitis is infection, most commonly by the bacteria Haemophilus influenzae type b (Hib). Other causes include:

1. Bacterial infections: Besides Hib, other bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, and group A Streptococcus can also cause epiglottitis, although these are less common than Hib.
2. Viral infections: Viruses such as influenza virus, parainfluenza virus, and varicella-zoster virus (which causes chickenpox and shingles) can lead to epiglottitis, especially in adults.
3. Fungal infections: In rare cases, fungal infections can cause epiglottitis, particularly in individuals with weakened immune systems.
4. Injury: Direct injury to the throat area, such as from a blow or a burn, can cause inflammation and swelling of the epiglottis.
5. Chemical exposure: Inhaling certain chemicals, fumes, or hot liquids can lead to irritation and inflammation of the epiglottis.
6. Foreign objects: In rare cases, a foreign object lodged in the throat can cause inflammation and swelling of the epiglottis.

Epiglottitis is now less common in children due to the Hib vaccine, which is routinely given as part of childhood immunizations. However, it can still occur in unvaccinated individuals or in those with certain risk factors.

How is the diagnosis of epiglottitis made?

Diagnosing epiglottitis typically involves a combination of medical history, physical examination, and imaging studies. Due to the potential for severe airway obstruction, diagnosis and treatment often occur simultaneously. Here’s how the diagnosis is typically made:

1. Medical history: Your healthcare provider will ask about your symptoms, including sore throat, difficulty swallowing, and difficulty breathing. They will also inquire about recent illnesses, vaccinations, and any risk factors for epiglottitis.
2. Physical examination: Your healthcare provider will perform a physical examination, which may include looking into your throat with a lighted instrument (laryngoscope) to examine the epiglottis. They will look for signs of inflammation, swelling, and obstruction.
3. Imaging studies: Imaging studies, such as X-rays or a CT scan, may be done to visualize the epiglottis and surrounding structures. These can help confirm the diagnosis and assess the extent of the inflammation and swelling.
4. Laboratory tests: Blood tests may be done to check for signs of infection, such as an elevated white blood cell count.
5. Direct visualization of the epiglottis: In some cases, direct visualization of the epiglottis may be necessary. However, this is usually done in a controlled setting, such as an operating room, due to the risk of airway obstruction.

It’s important to seek immediate medical attention if you or someone you know is experiencing symptoms of epiglottitis, as early diagnosis and treatment are crucial to prevent complications and ensure a positive outcome.

What is the treatment for epiglottitis?

The treatment for epiglottitis usually involves hospitalization and immediate intervention to maintain a clear airway and treat the underlying infection. Treatment may include:

1. Airway management: If there is severe airway obstruction, the healthcare team may need to secure the airway by inserting a breathing tube (intubation) or performing a tracheostomy (creating a surgical opening in the trachea) to ensure adequate oxygenation.
2. Antibiotics: Antibiotics are typically given to treat the underlying bacterial infection. The choice of antibiotic depends on the suspected or identified bacteria and may include intravenous antibiotics such as ceftriaxone, cefotaxime, or ampicillin-sulbactam.
3. Corticosteroids: Corticosteroids may be used to reduce airway inflammation and swelling. They are often given in conjunction with antibiotics.
4. Fluids and nutrition: Intravenous fluids may be given to maintain hydration and nutrition, especially if swallowing is difficult.
5. Monitoring: Close monitoring of vital signs, oxygen saturation, and airway status is essential. In severe cases, monitoring may occur in an intensive care unit (ICU).
6. Prevention of complications: Treatment also focuses on preventing complications such as respiratory failure, sepsis, and secondary infections.
7. Vaccination: In some cases, the Hib vaccine may be administered if the patient has not been previously vaccinated, to prevent future episodes of Hib-related epiglottitis.

It’s important to seek immediate medical attention if you suspect epiglottitis, as prompt treatment is crucial to prevent serious complications, such as airway obstruction, respiratory failure, and sepsis.

What are the 4 D’s of epiglottitis?

The 4 D’s of epiglottitis are a historical teaching tool used to describe the common symptoms of epiglottitis. They are:

1. Drooling: Due to difficulty swallowing caused by the swollen epiglottis, affected individuals may drool excessively.
2. Dysphagia: Dysphagia refers to difficulty swallowing, which is a common symptom of epiglottitis.
3. Dysphonia: Dysphonia is hoarseness or changes in the voice, which can occur due to inflammation of the throat and vocal cords.
4. Distress: Distress refers to signs of respiratory distress, such as difficulty breathing, stridor (a high-pitched sound when breathing in), and retractions (visible sinking of the skin between the ribs and in the neck during breathing).

These symptoms can rapidly progress and lead to life-threatening airway obstruction, which is why prompt recognition and treatment of epiglottitis are essential. It’s important to note that while these symptoms were once considered classic for epiglottitis, the widespread use of the Hib vaccine has made the condition much less common, especially in children.