Epiglottitis is a condition characterized by the inflammation of the epiglottis, the flap-like tissue at the base of the tongue.
Swift identification and treatment are crucial to prevent serious complications and ensure positive outcomes.
This article delves into the causes, symptoms, diagnosis, and management of epiglottitis, providing a comprehensive overview of this critical respiratory condition.
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What is Epiglottitis?
Epiglottitis is a potentially life-threatening condition characterized by the inflammation of the epiglottis, the flap at the base of the tongue that keeps food from entering the windpipe. Often caused by bacterial infections, it can lead to sudden respiratory failure if not promptly diagnosed and treated.
Epiglottitis is primarily caused by a bacterial infection, with Haemophilus influenzae type b (Hib) being historically the most common culprit.
However, due to the widespread use of the Hib vaccine, instances linked to this bacterium have significantly decreased.
Other bacteria like Streptococcus pneumoniae, Streptococcus A, B, or C, and Staphylococcus aureus can also lead to epiglottitis.
In some cases, it can result from viral or fungal infections, and in rare instances, physical injury to the throat, such as a direct blow or ingestion of a hot liquid or chemical, can trigger the condition.
Additionally, adults face a risk from other factors such as smoking, alcohol abuse, and a weakened immune system, which can contribute to the development of epiglottitis.
Signs and Symptoms
Epiglottitis presents with a range of signs and symptoms that can quickly escalate, warranting immediate medical attention.
Some of the most common examples include:
- Severe Sore Throat and Pain: This is often one of the first and most prominent symptoms, making swallowing painful and difficult.
- Difficulty Breathing: As the inflamed epiglottis obstructs the airway, patients may experience difficulty breathing, which can manifest as rapid, shallow breathing or stridor (a high-pitched whistling sound during breathing).
- Fever: A high fever usually accompanies the inflammation.
- Change in Voice: The condition may cause a muffled or hoarse voice, often described as “hot potato” voice due to the effort in speaking.
- Drooling: Difficulty in swallowing and throat pain can lead to excessive drooling, as the patient is unable to swallow saliva comfortably.
- Altered Posture: To ease breathing difficulties, individuals with epiglottitis may instinctively sit up or lean forward, often referred to as the “tripod” position.
- Irritability and Restlessness: Particularly in children, these behavioral changes can be indicative of distress caused by difficulty in breathing and swallowing.
Note: Epiglottitis can evolve swiftly, sometimes over hours. Unlike common throat infections, it often escalates quickly and requires immediate medical intervention. If epiglottitis is suspected, emergency medical services should be contacted rather than attempting to transport the patient to a hospital by private means, as any delay or agitation can worsen the airway obstruction.
The treatment of epiglottitis focuses on ensuring an open airway, controlling the infection, and addressing any associated complications.
Given the potential for rapid progression, treatment typically involves immediate hospitalization, often in an intensive care setting.
Key components of treatment include:
- Securing the Airway: The top priority is to make sure the patient can breathe. This often involves endotracheal intubation to keep the airway open. In severe cases, a tracheostomy may be necessary.
- Antibiotics: Since bacterial infection is a common cause, intravenous antibiotics are administered promptly to combat the infection. The choice of antibiotic may depend on the suspected or confirmed causative agent.
- Supportive Care: This includes oxygen therapy, fluids to prevent dehydration (especially if the patient has difficulty swallowing), and pain management.
- Monitoring and Support: Continuous monitoring of vital signs, oxygen levels, and other pertinent parameters is essential to detect any signs of worsening condition or complications.
Patients with epiglottitis typically need to stay in the hospital until they show significant improvement, particularly in their ability to breathe and swallow without difficulty.
Once the acute phase is managed and the patient is stable, the focus shifts to recovery and prevention of recurrence, which may involve vaccination updates or addressing underlying chronic health issues.
Post-hospitalization, a follow-up with an otolaryngologist or primary care provider is often recommended to ensure complete recovery and manage any lingering issues or complications.
Epiglottitis Practice Questions
1. What is epiglottitis characterized by?
Epiglottitis is characterized by inflammation and swelling of the epiglottis, leading to symptoms like severe sore throat, difficulty swallowing, fever, altered voice, difficulty breathing, and stridor. It’s a medical emergency due to the risk of airway obstruction.
2. What vaccine has helped decrease the incidence of epiglottitis in children?
Haemophilus influenzae type B
3. What is the clinical presentation of epiglottitis?
Sudden onset of fever, respiratory distress, severe dysphagia, drooling, muffled voice, mild stridor with little or no coughing and tripoding.
4. What are the diagnostic studies for epiglottitis?
Direct visualization with caution because it may be fatal in children, CBC and blood cultures, and a lateral neck x-ray.
6. How can you manage epiglottitis as a respiratory therapist?
The primary focus is to secure the airway.
7. How do you differentiate croup from epiglottitis?
Lateral neck x-ray
8. Why is epiglottitis more common in two to four-year-olds?
The shape of their epiglottis is more omega-shaped than the adult “u” shape.
9. What are the most common signs and symptoms of epiglottitis?
The most common signs and symptoms of epiglottitis are severe sore throat, difficulty breathing with a high-pitched wheezing sound, fever, a muffled or hoarse voice, and excessive drooling.
10. What are the most common causes of epiglottitis?
The most common causes of epiglottitis are bacterial infections, particularly Haemophilus influenzae type b (Hib), though it can also be caused by other bacteria and viruses.
11. What airway sound will you hear in patients with epiglottitis?
12. What does the throat of a patient with epiglottitis look like?
Swollen and cherry red
13. What does epiglottitis require?
Immediate attention because inflamed tissue can block the airway.
14. What is a predisposing factor of epiglottitis?
15. In what ages does epiglottitis mainly occur in children?
2 to 7 years old
16. What is used to confirm the diagnosis of epiglottitis?
17. What color is the epiglottis is patients with epiglottitis?
18. What clinical signs are often seen in children with epiglottitis?
Tripod posture, anxious, prefers to sit, sniffling position to maximize patency of airway, fever, respiratory distress, dysphagia, and drooling.
19. What does the epiglottis look like in epiglottitis?
Inflamed, swollen, cherry-red, tissue blocking the airway, erythematous, and edematous.
20. What type of pathogen is a concern for epiglottitis in immunocompromised patients?
21. What are the non-infectious causes of epiglottitis?
Trauma by foreign objects, inhalation and chemical burns, other diagnoses, reactions to chemotherapy, and inhalation of heated objects when smoking illicit drugs.
22. Which age group gets epiglottitis most often?
Children aged 2-7 years old, but it may occur at any age.
23. What is the most common cause of acute epiglottitis?
Haemophilus influenzae type B
24. What are some of the organisms that cause epiglottitis?
Streptococcus pyogenes (group A), streptococcus pneumoniae, non-typable haemophilus influenzae, and staphylococcus.
25. What is the most common presentation of epiglottitis in adults?
26. How does epiglottis present?
Epiglottitis typically presents with a sudden onset of severe sore throat, pain when swallowing, high fever, difficulty breathing often accompanied by stridor (a high-pitched, wheezing sound), a muffled or hoarse voice, and excessive drooling. The individual may adopt a sitting or leaning forward position to ease breathing. Due to the risk of rapid airway obstruction, it’s considered a medical emergency.
27. What are the four D’s of epiglottitis?
Drooling, dysphagia, distress, and dysphonia.
28. What is the tripod position?
The patient sits forward, supported by both hands; the neck is extended, and the chin is out.
29. Why may the neck be hyperextended in a child with epiglottitis?
This is an attempt to maintain the airway.
30. How do you diagnose epiglottitis?
Laryngoscopy under controlled circumstances reveals a large cherry red and swollen epiglottitis. Sometimes, the aryepiglottic folds are more involved than the epiglottis.
31. When is laryngoscopy indicated if the diagnosis of epiglottitis is certain or probable based on clinical findings?
Immediately, but in a controlled environment.
32. Do you intubate a patient with probable epiglottitis first?
No, you must first get a lateral neck x-ray to confirm.
33. What is performed next after a lateral neck x-ray shows epiglottitis?
34. Which patients with epiglottitis should be intubated?
All; regardless of the degree of respiratory distress.
35. How long should a patient with epiglottitis be intubated?
It depends on the clinical course and the duration of epiglottic swelling as determined by laryngoscopy. Most children are intubated and on the ventilator for 2-3 days because the response to antibiotics is rapid.
36. What is the definitive treatment for epiglottitis?
Intubation in a controlled environment.
37. Are racemic epinephrine and corticosteroids effective in treating epiglottitis?
No, they are not effective.
38. What investigations should be done in patient with epiglottitis?
After you have stabilized the airway (i.e., intubation), a blood culture, epiglottic surface culture, and, in some cases, CSF.
39. What can be expected after intubating a child with epiglottitis?
There should be immediate improvement; respiratory distress and cyanosis should be resolved.
40. Can epiglottitis be resolved after a few days of antibiotics?
Yes, and the patient can be extubated, but antibiotics are continued for a total of 10 days.
41. How do you know that epiglottic swelling is resolving?
It must be confirmed by visualization (i.e., laryngoscopy).
42. What is the number one danger of epiglottitis?
43. What organism causes epiglottitis?
Hemophilus influenza B
44. What level of fever is present in epiglottitis?
102 degrees F
45. What are the classic symptoms of epiglottitis?
A muffled voice, drooling, and stridor.
46. Will a child with epiglottitis cough?
No, they have a lack of a spontaneous cough.
47. How will a child with epiglottitis breathe?
They are often leaned forward with flaring nostrils.
48. What drugs are used to treat epiglottitis?
Penicillin and Ampicillin
49. What behavior indicates the need for a tracheotomy?
Restlessness, increased heart rate, and retractions.
50. What is recommended to prevent epiglottitis?
Children two months and older should receive the H. Influenzae B vaccine.
51. What position will patients with epiglottitis often be seen in?
52. What can happen if you use a tongue blade on a patient with epiglottitis?
Laryngospasm; therefore, you should never use it.
53. What tool helps with the diagnosis of epiglottitis?
54. Is epiglottitis an emergency?
Yes, epiglottitis is a medical emergency.
55. How quickly does epiglottitis progress?
It can progress rapidly, often within hours.
Recognizing and responding to epiglottitis with urgency is essential due to its potential to obstruct the airway and pose severe respiratory complications.
As medical professionals, being well-versed in the signs and therapeutic interventions associated with this condition is essential.
With prompt medical intervention, most patients with epiglottitis can recover fully and lead a normal, healthy life.
Continual education and awareness are paramount in ensuring that we, as practitioners, remain at the forefront of patient care for those affected by this condition.
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- Guerra AM, Waseem M. Epiglottitis. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.