Epiglottitis is a severe bacterial infection of the epiglottis, which can block the windpipe, obstructing air flow.
The epiglottis is a small flap of tissue that closes the entrance to the voice box (larynx) and windpipe (trachea) during swallowing. In the past, epiglottitis was most common among children 2 to 5 years old and was usually caused by the bacterium Haemophilus influenzae type b. Now that most children are vaccinated against Haemophilus influenzae type b, the disease is quite rare and is more common among adults (see Throat Disorders: Epiglottitis). In adults, it is typically caused by Streptococcus pneumoniae, other streptococci, and staphylococci. Children with epiglottitis often have bacteria in the bloodstream (bacteremia), which sometimes spreads the infection to the lungs, the joints, the tissues covering the brain (meninges), the sac around the heart, or the tissue beneath the skin.
The infection usually begins suddenly and progresses rapidly. A previously healthy child develops a sore throat and often a high fever. The child may be irritable and anxious. Difficulties in swallowing and breathing are common. The child usually drools, breathes rapidly, and makes a loud noise while inhaling (called stridor). The difficulty in breathing often causes the child to lean forward while stretching the neck backward to try to increase the amount of air reaching the lungs. Labored breathing may lead to a buildup of carbon dioxide and low oxygen levels in the bloodstream, causing agitation and confusion followed by sluggishness (lethargy). The swollen epiglottis makes coughing up mucus difficult. Epiglottitis can quickly become fatal because swelling of the infected tissue may block the airway and cut off breathing.
Epiglottitis is an emergency, and a child is hospitalized immediately when a doctor suspects it. If the child does not have all of the typical symptoms of epiglottitis and does not appear seriously ill, the doctor sometimes takes an x-ray of the neck, which can show an enlarged epiglottis. The doctor does not hold the child down or use a tongue depressor to look in the throat. These manipulations may cause throat spasm and complete airway blockage in a child with epiglottitis.
If an enlarged epiglottis is seen on x-ray or the child appears seriously ill, doctors examine the child under anesthesia in the operating room. The doctor inserts a thin flexible tube (laryngoscope) into the throat to directly view the larynx.
Prevention of epiglottitis is better than treatment. Prevention is achieved by ensuring that all children receive the Haemophilus influenzae type b and Streptococcus pneumoniae conjugate vaccines.
If the examination shows epiglottitis or triggers throat spasm, the doctor inserts a plastic tube (endotracheal tube) into the airway to keep it open. If the airway is too swollen to allow placement of an endotracheal tube, the doctor cuts an opening through the front of the neck (tracheostomy) and inserts the tube. This tube is left in place for several days until the swelling of the epiglottis goes down. The child also receives antibiotics, such as ceftriaxone or ampicillin-sulbactam. Once the child's airway is opened, the prognosis is good.
Last full review/revision June 2006 by Geoffrey A. Weinberg, MD