What is Epiglottitis?
Physiologically, the epiglottis is a small flap of cartilage that acts as a lid for your windpipe to keep food or fluids from entering the airway. Normally this flap stays open to allow air to flow into the windpipe, and closes during swallowing. Epiglottitis is the inflammation of this flap that can, in severe cases, actually keep air from entering the airway.
There are a number of possible causes for this inflammation including burns from swallowing hot liquids, and direct injury to the throat, but the most common cause is the Influenza B virus, which is also responsible for pneumonia, meningitis, ear infections, and sinus infections. The swelling can also be caused by strains of Pneumococcus, Streptococcus, Staphylococcus, or Klebsiella bacteria. It is possible for children who have had their HIB vaccine to still experience epiglottitis. In rare cases, the herpes simplex virus has also been associated with development of viral epiglottitis, though it is extremely rare.
Interestingly, according to emedicinehealth.com, "although George Washington's death in 1796 was attributed to quinsy (today we call it peritonsillar abscess), which is a pocket of pus behind the tonsils, it was actually due to epiglottitis."
Conservative estimates put the number of cases at 10 to 40 for every one million people in the U.S. Since the introduction of the HIB vaccine in 1985, the number of cases of the condition has been drastically reduced.
Epiglottitis affects children between the ages of two and seven and peaks between ages two and four, and for adults between the ages of 20 and 40. It is very rare that epiglottitis occurs in infants (younger than one year), making up about 4 percent of all total reported cases.
Symptoms of Epiglottitis
Since this little piece of cartilage can create much havoc if it isn't working properly, symptoms of epiglottitis will come on quickly, although some cases have reported a gradual onset of symptoms over a period of a few hours to a few days. Most commonly, symptoms include:
- sore throat
- changes in voice
- difficulty speaking
- fever (between 37.2C / 99F and 37.8C / 100.1F)
- difficulty swallowing
- increased heart rate
- difficulty breathing
Watch for signs of respiratory distress such as:
- drooling
- leaning forward to breathe (children may appear as though they were sniffing a pie)
- rapid shallow breaths
- pulling in of muscles in the neck or between the ribs
- high-pitched whistling sound when breathing (stridor)
Epiglottitis in adults has been divided into three categories:
Category 1 is severe respiratory distress with imminent or actual respiratory arrest. This is usually the case with rapid onset of symptoms;
Category 2 has moderate-to-severe clinical symptoms such as sore throat, inability to swallow, difficulty lying flat, muffled voice (sounds like they're speaking with a mouthful of hot potato), stridor, and the sucking in of respiratory muscles when breathing.
Category 3 has mild to moderate symptoms without potential of windpipe blockage. Patients with category 3, usually report several days of sore throat and pain on swallowing.
Diagnosis and Treatment of Epiglottitis
If you suspect you have Category 1 or 2 epiglottitis, or suspect some you know has it, seek medical attention immediately. It is an emergency situation that left untreated can be fatal. Using tongue depressors to look at the site may, in fact, worsen the condition.
Clinical examination will involve the use of a small mirror held against the back of the throat or a laryngoscope (a viewing tube). Blood cultures or throat cultures may be taken to confirm the presence of H. influenzae or other bacteria. Doctors may opt to do a complete blood count. They will be looking for elevated levels of white blood cells. Neck X-rays may also be taken.
Treatment may include a breathing tube or moist (humid) oxygen to help the patient breathe. Antibiotics may be administered to help fight off the infection. Anti-inflammatory corticosteroids may be used to diminish the swelling. Fluids may be administered through an IV (intravenous) to keep the patient hydrated.
Sources:
emedicinehealth.com
www.mayoclinic.com
www.nlm.nih.gov
www.pdrhealth.com