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Epiglottitis

Definition:
Epiglottitis is the severe swelling of the epiglottis. The epiglottis is a flap like, cartilage structure, located in the throat. During swallowing, the epiglottis folds over the windpipe and vocal chords to prevent food and liquids from entering the lungs. Swelling can quickly seal off a person’s airway making it difficult for them to breathe. Epiglottitis is rare, and requires immediate medical attention, as it can quickly turn deadly. If you think you, your child, or someone you know has epiglottitis, go to the emergency room immediately.

Causes:
Factors that can cause epiglottitis include:
  • Bacteria, viruses, and fungi , such as:
    • Haemophilus influenzae type b (Hib) - not the same germ that causes the flu; the cause of the most deadly type of epiglottis
    • Streptococcus pneumoniae - also the cause of meningitis
    • Streptococcus A, B, and C - also the cause of strep throat and blood infections
    • Candida albicans - also causes yeast infections, diaper rash, and oral thrush
    • Varicella zoster - also causes chicken pox and shingles
  • Burns from hot liquids
  • Physical injury to the throat area

Bacterial infections usually cause epiglottitis. In the past, Hib most frequently caused epiglottitis. However, since vaccination against this virus was started in children, it has actually become more prevalent among adults than children.

Risk Factors:
Epiglottitis is a contagious disease. It is passed much like the common cold, through droplets released when sneezing and coughing. Anyone can develop epiglottitis, however the following factors can increase a person’s risk:
  • Age
    • Children ages 2-6 in countries that do not offer vaccines
    • Infants too young to receive vaccination (younger than 2 months)
    • Adults in their 40s (very rare)
  • Sex
    • Males are more prone than females
    • Close quarters
    • Daycare
    • Schools
    • Offices
    • Family members
  • Weak immune system
    • Illness
    • Medications that reduce immune function
Symptoms:
Epiglottitis is a rare disease, if you or your child experiences any of these symptoms, do not assume it is due to epiglottitis. These symptoms may be caused by other, less serious health conditions. However, if you experience any one of them, see your physician.
  • High fever (~103°F)
  • Sore throat and sever throat pain
  • Difficulty swallowing
  • Muffled voice
  • Breathing problems:
    • Rapid breathing
    • Increasingly difficult breathing
    • Leaning forward and arching the neck backward to breathe
    • Stridor (squeaky or raspy sounds while inhaling, caused by airway blockage)
  • Symptoms associated with low oxygen levels:
    • Cyanosis (bluish tint to skin or lips)
    • Sluggishness
    • Confusion
    • Irritability

Symptoms appear suddenly, and worsen quickly.

Note: Do not attempt to use a tongue depressor or any other utensil to look into the person’s throat. A throat spasm could occur, and cause the airway to close completely.

Diagnosis:
When you arrive at the hospital, the doctor will first make sure the patient is able to breathe. After the airway is secured, the doctor will ask about symptoms and medical history. If the person is not having trouble breathing, the doctor may use a mirror to look down the throat. Usually, initial diagnosis and testing are based on the reported symptoms.

Tests that may be run include:

  • Chest X-ray - a test that uses radiation to take a picture of the chest, so the doctor can check for a swollen epiglottis
  • Blood tests - to screen for bacteria
  • Nasopharyngoscopy - a tiny-lighted tube inserted through the nose to look at structures like the epiglottis
  • Throat culture - a cotton swab is used to collect cells from the infected tissue; the cells are plated on a nutrient rich medium, and allowed to grow; the cells are then identified, and the results are given to the doctor
Treatment:
The doctor will first stabilize the patient’s airway, and then give proper medication depending on the cause. The patient may also have secondary illnesses that need to be treated depending on the cause of the epiglottitis (e.g., Streptococcus can cause blood infections).

If the person is NOT having trouble breathing, he or she will be closely monitored in the intensive care unit.

If the person CANNOT breathe, the options include:

  • Endotracheal intubation: A breathing tube is inserted through the nose, or mouth, and fed into the airway. This can only be done if the airway is not swollen shut.
  • Tracheotomy: A breathing tube is inserted directly into the trachea (airway). This is done if the airway is swollen shut, or if the airway is too swollen to do an endotracheal intubation.

After the airway is stabilized, the person will be monitored, and started on medications, including:

  • Antibiotics: Antibiotics given through the veins (IV) help to kill the organism causing the infection and swelling. At first a variety of antibiotics may be given if the identity of the germ is not yet known. Once the laboratory test results are known, a specific antibiotic can be given.

Once swelling decreases, the breathing tube can be removed. Usually, there are not any lasting side effects of epiglottitis, and the outlook for the patient is good.

Prevention:
Vaccination is the only way to prevent epiglottitis. There are three different vaccines that can be given (HbOC, PRP-OMP, and PRP-T). Currently, infants born in the U.S. are given one of these vaccines at two months of age. Since vaccination began, adults have been at even lower risk of developing epiglottis. However, if you are immune compromised, or on medications that may make you more susceptible to illness, speak with your doctor about the possibility of getting vaccinated.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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