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Epiglottitis

(Supraglottitis)

by Clarence T. Sasaki, MD

Epiglottitis is a bacterial infection of the epiglottis and surrounding tissues.

  • Epiglottitis may block the windpipe (trachea) and be fatal.

  • The main symptoms are severe sore throat and noisy, difficult breathing.

  • Doctors make the diagnosis by looking at the epiglottis in the operating room with a flexible light.

  • The Haemophilus influenzae type B (Hib) vaccine can prevent epiglottitis caused by these bacteria.

  • Antibiotics are given to eliminate the infection, and a breathing tube is inserted to keep the airway from swelling shut.

The epiglottis is a small flap of stiff tissue that closes the entrance to the voice box (larynx) and trachea during swallowing.

Causes

Sometimes, the epiglottis becomes infected with bacteria, usually Haemophilus influenzae type B. Haemophilus influenzae–related epiglottitis was most common among children, but routine vaccination against Haemophilus has almost eliminated this infection in children. Now more cases of epiglottitis occur in adults. However, children may get epiglottitis caused by other bacteria, and adults and unvaccinated children can still be infected by Haemophilus influenzae type B.

The swelling caused by this infection may block the airway and lead to difficulty breathing and death. Because children have a smaller airway than adults, epiglottitis is much more dangerous in children but can also be fatal in adults.

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 tissues beneath the skin.

Symptoms

In children, symptoms develop suddenly, and fatal narrowing of the larynx can occur within a few hours of the start of symptoms. Symptoms include severe throat pain, difficulty swallowing, pain with swallowing, fever, drooling, and a muffled voice. Because the infection is in the epiglottis, the back of the throat often does not appear infected. As swelling of the epiglottis starts to narrow the airway, the child first begins to make a squeaking noise when breathing in (stridor) and then has progressively worse trouble breathing. The condition progresses rapidly.

In adults, symptoms are similar to those of children, including sore throat, fever, difficulty swallowing, and drooling, but symptoms usually take more than 24 hours to develop. Because the adult airway is larger, blockage of the airway is less common and less sudden. Often, there is no visible inflammation in the throat. Thus, when people have severe throat pain but a normal-appearing throat, doctors may suspect they have epiglottitis.

Diagnosis

Doctors suspect the diagnosis in people with a severe sore throat but no throat infection (pharyngitis) and also in people with a sore throat and stridor. Because epiglottitis is an emergency, people who are suspected of having it are hospitalized. To confirm the diagnosis, doctors need to directly inspect the epiglottis. If an adult is not having stridor or any trouble breathing, the doctor may look down the throat with a mirror or a thin, flexible viewing tube inserted into the throat (flexible fiberoptic laryngoscopy) or take x-rays. Children are more likely to have sudden, complete blockage of their airway, particularly when their throat is examined. To minimize this danger, doctors examine the throat and epiglottis only in the operating room and do not send children for x-rays.

Prevention and Treatment

Epiglottitis caused by Haemophilus influenzae type B can be effectively prevented with the Haemophilus influenzae type B (Hib) vaccine.

The most important thing doctors do is make sure the person's airway is open. Doctors take children to the operating room and insert a plastic breathing tube through the nose into the trachea (nasotracheal intubation). The tube keeps the airway from swelling shut. Doctors also place a breathing tube in adults who are having difficulty breathing, whose airway is severely blocked, or both. However, adults who do not have difficulty breathing do not need a breathing tube and can be closely observed in an intensive care unit.

All adults and children with epiglottitis are given antibiotics (such as ceftriaxone).

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