Epiglottis

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Overview

Epiglottitis is an inflammatory condition, usually infectious in origin, of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula. Epiglottitis is a life-threatening condition that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.

Before the development of the Haemophilus influenzae type b vaccine, the majority of cases were caused by H.influenzae and the condition was far more common. In the post-vaccine era, the pathogens responsible are more varied and can also be polymicrobial. For this reason, the term "supraglottitis" is often preferred, as the infections may affect the supraglottic structures more generally. Edema due to infection of the epiglottis and supraglottic structures can be gradually progressive until a critical mass is reached, and the clinical scenario can rapidly deteriorate and lead to airway obstruction, respiratory distress, and death. Symptoms can be exacerbated by patient discomfort and agitation, particularly in children, so any patient with a diagnosis of true supraglottitis must have their airway secured under the most controlled circumstances possible, and every attempt should be made to keep the patient as calm and comfortable as possible until an airway is secured. The airway should not be instrumented for oral exams or endoscopy in the clinic or Emergency Department, and no patient with a potentially unstable airway should be sent to the radiology department for imaging.

Symptoms

Epiglottitis symptoms usually appear suddenly and get worse quickly. Sometimes, in older children and adults, it may take a few days for symptoms to fully develop. The most common epiglottitis symptoms include:

Fever.

Severe sore throat.

Abnormal, high-pitched sound when breathing in (stridor)

Difficult and painful swallowing.

Drooling.

Anxious, restless behavior.

Feeling better when sitting up or leaning forward.

Causes

The most common cause of epiglottitis in children in the past was infection with Haemophilus influenzae type b (Hib), the same bacterium that causes pneumonia, meningitis and infections in the bloodstream. Epiglottitis can occur at any age.

In most cases, Haemophilus influenza type b (Hib) bacteria cause epiglottitis. This is sometimes called acute bacterial epiglottitis. Hib bacteria can also cause pneumonia and meningitis.


Other possible epiglottis causes include:


Bacterial infections from non-Hib sources, such as those from streptococcus pneumonia.

Fungal infections, particularly in people with a weak immune system.

Viral infections from varicella zoster virus (which causes chickenpox) or herpes simplex virus (which causes cold sores).

Injury to your throat, either through a physical blow or by drinking a very hot liquid.

Smoking.

Chemical burns.

Side effect of another disease or chemotherapy.

Risk factors

Certain factors increase the risk of developing epiglottitis, including:


Being male. Epiglottitis affects more males than females.

Having a weakened immune system. If your immune system has been weakened by illness or medication, you're more susceptible to the bacterial infections that may cause epiglottitis.

Lacking adequate vaccination. Delayed or skipped immunizations can leave a child vulnerable to Hib and increases the risk of epiglottitis.

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Complications

Complications of epiglottitis include the following:

Cellulitis.

Cervical adenitis.

Death.

Empyema.

Epiglottic abscess.

Meningitis.

Pneumonia.

Pulmonary edema.

Prevention

Immunization with the Hib vaccine is an effective way to prevent epiglottitis caused by Hib . In the United States, children usually receive the vaccine in three or four doses: At 2 months. At 4 months. At 6 months if your child is being given the four-dose vaccine.

While you can’t prevent epiglottitis altogether, there are things you can do to significantly reduce your risk:


Make sure vaccinations are up to date. In children, the best prevention is to ensure all childhood immunizations are up to date. Children have undeveloped immune systems. This makes them more vulnerable to infections, including Hib bacteria.

Practice good hygiene. Wash your hands frequently, and avoid placing fingers in your eyes, nose and mouth.

Protect yourself from infection. Take necessary precautions around people who are coughing and sneezing.

Avoid injury to your throat. Drinking hot liquids or smoking can increase your risk of epiglottitis.