Epiglottiditis

Epiglottiditis, an acute inflammation of the epiglottis and surrounding area, is a life-threatening emergency that rapidly causes edema and induration. Untreated, epiglottiditis results in complete airway obstruction. Epiglottiditis can occur from infancy to adulthood in any season. It's fatal in 8% to 12% of patients, typically children between ages 2 and 8.

Causes

Epiglottiditis usually results from infection with the bacteria Haemophilus influenzae type B and, occasionally, pneumococci or group A streptococci.

Signs and Symptoms

This condition is more common in children than adults. When epiglottitis is caused by an infection, the person may have fever, severe sore throat, and drooling. There is often very noisy breathing when drawing in air. The harder the individual tries to breathe, the louder the breathing. Those with acute epiglottitis tend to lean forward and hold very still. This minimizes the obstruction. Epiglottitis is a true medical emergency in children and some adults.

Diagnostic tests

Lateral neck X-rays show an enlarged epiglottis and distended hypopharynx.

Direct laryngoscopy reveals the hallmark of acute epiglottiditis: a swollen, beefy-red epiglottis. The throat examination should follow X-ray studies and, in most cases, shouldn't be performed if significant obstruction is suspected or if immediate intubation isn't possible.

Additional X-rays of the chest and cervical trachea help to confirm the diagnosis.

Treatment

A patient with acute epiglottiditis and airway obstruction requires emergency hospitalization. He should be placed in a cool-mist tent with added oxygen. If complete or near-complete airway obstruction occurs, he may also need emergency endotracheal intubation or a tracheotomy. Arterial blood gas (ABG) monitoring or pulse oximetry may be used to assess his progress.

Treatment may also include parenteral fluids to prevent dehydration when the disease interferes with swallowing, and a 10-day course of parenteral antibiotics - usually ampicillin. If the patient is allergic to penicillin or could have ampicillin-resistant endemic H. influenzae, chloramphenicol or another antibiotic may be prescribed.

Although controversial, corticosteroids may be prescribed to reduce edema during early treatment. Oxygen therapy may also be used.

Keep in mind that preventive measures should be taken. In 1990, the American Academy of Pediatrics recommended that all children receive the haemophilus b conjugate vaccine, preferably at age 2 months. As more children become immunized, epiglottiditis rates should decline.

Prevention

The Haemophilus influenzae type B, or Hib vaccine helps to prevent a common infection leading to epiglottitis in children. Since the Hib vaccine was developed, there has been a decline in epiglottitis cases for those vaccinated. Preventing other causes is often not possible.