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.

The Throat

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Causes

Factors that can cause epiglottitis include:

• Bacteria, viruses, and fungi , such as:
  • Haemophilus influenzae type b (Hib)—the most common cause and the cause of the most deadly type of epiglottitis; not the same germ that causes the flu]]>
  • Streptococcus pneumoniae —also the cause of ]]>meningitis]]>
  • Streptococcus A, B, and C—also the cause of ]]>strep throat]]> and blood infections
  • Candida albicans —also the cause of ]]>yeast infections]]> , diaper rash, and oral thrush
  • Varicella zoster —also the cause of ]]>chickenpox]]> and ]]>shingles]]>
• ]]>Burns]]> from hot liquids
• Physical injury to the throat area
• ]]>Crack cocaine]]>

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, aged 3-7, living in countries that do not offer vaccines
  • Infants too young to receive vaccination (younger than two months)
  • Adults in their 40s (very rare)
• Sex: Males are more prone than females.
• Living in close quarters
• Attending day care, being in school, or working in an office
• Weather: more common in winter
• Race: more common among African Americans and Hispanics

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.

• Cough]]>
• High fever (over 103°F)
• ]]>Sore throat]]> and severe throat pain
• Difficulty swallowing with drooling
• 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 you are able to breathe. Once this is affirmed, the doctor will ask about your symptoms and medical history. If you are not having trouble breathing, the doctor may use a mirror to look down your throat. Usually, initial diagnosis and testing are based on the reported symptoms.

Tests that may be run include:

• Neck x-ray]]> —a test that uses radiation to take a picture of the neck, so the doctor can check for a swollen epiglottis
• Blood culture—to screen for bacteria
• Blood count—to document presence of bacterial infection
• Nasolaryngoscopy—a tiny, lighted tube inserted through the nose to look at structures like the epiglottitis
• 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 your airway and then give proper medication depending on the cause. You may also have secondary illnesses that need to be treated depending on the cause of the epiglottitis (eg, blood infections due to Streptococcus ).

If you CAN breathe, you will be closely monitored in the intensive care unit.

If you 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 and should be done by an experienced physician.
• 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, you will be monitored and started on medications, including:

• Antibiotics—Antibiotics given through the veins (IV) help 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 is good.

If you are diagnosed with epiglottitis, follow your doctor's instructions.

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 US are given one of these vaccines at two months of age. Since vaccination began, adults have been at even lower risk of developing epiglottitis. 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. An antibiotic (ie, rifampin) may be prescribed for post-exposure coverage for:

• Household members and others who have spent time in the previous 5 out of 7 days with an affected individual
• All day care staff