Epiglottitis

Epiglottitis

Definition:

Epiglottitis is a potentially life-threatening condition that occurs when the epiglottis — a small cartilage "lid" that covers your windpipe — swells, blocking the flow of air into your lungs.

A number of factors can cause the epiglottis to swell — burns from hot liquids, direct injury to your throat and various infections. 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.

Routine Hib vaccination for infants has made epiglottitis rare, but epiglottitis remains a concern. If you suspect that you or someone in your family has epiglottitis, seek emergency help immediately. Prompt treatment can prevent life-threatening complications.

Symptoms:

Symptoms in children
In children, signs and symptoms of epiglottitis may develop within a matter of hours, including:

• Fever
• Severe sore throat
• Abnormal, high-pitched sound when breathing in (stridor)
• Difficult and painful swallowing
• Drooling
• Anxious, restless behavior
• Greater comfort when sitting up or leaning forward

Symptoms in adults
For adults, signs and symptoms may develop more slowly, over days rather than hours. Signs and symptoms may include:

• Severe sore throat
• Fever
• A muffled or hoarse voice
• Abnormal, high-pitched sound when breathing in (stridor)
• Difficulty breathing
• Difficulty swallowing

When to see a doctor
Epiglottitis is a medical emergency. If you or someone you know suddenly has trouble breathing and swallowing, call your local emergency number or go to the nearest hospital emergency department. Try to keep the person quiet and upright, because this position may make it easier to breathe. Don't try to examine the person's throat yourself. This can make matters worse.


Causes:

Epiglottitis is caused by an infection or an injury.
Infection
A common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection with Haemophilus influenzae type b (Hib) bacteria. Hib is responsible for a number of serious conditions, the most common of which is meningitis.

Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib in your nose and throat without becoming sick — though you still have the potential to spread the bacteria to others.

Other bacteria and viruses also can cause inflammation of the epiglottis, including:

• Streptococcus pneumoniae (pneumococcus), another bacterium that can cause meningitis, pneumonia, ear infections and blood infection (septicemia)
  
• Streptococcus A, B and C, a group of bacteria that also can cause diseases ranging from strep throat to blood infections

Injury
Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can burns from drinking very hot liquids.
You also may develop signs and symptoms similar to those of epiglottitis if you:

• Swallow a chemical that burns your throat
• Swallow a foreign object
• Smoke drugs, such as crack cocaine

Complications:

Epiglottis can cause a number of complications, including:

• Respiratory failure. The epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering your windpipe. But if the epiglottis becomes swollen — either from infection or from injury — the airway narrows and may become completely blocked. This can lead to respiratory failure — a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high.
  
• Spreading infection. Sometimes the bacteria that cause epiglottitis cause infections elsewhere in the body, such as pneumonia, meningitis or a blood infection (sepsis).

Treatments and drugs:

Treatment of epiglottis involves first making sure you or your child can breathe, and then treating any identified infection.

Helping you breathe
The first priority in treating epiglottitis is ensuring that you or your child is receiving enough air. This may mean:

• Wearing a mask. The mask delivers oxygen to the lungs.
  
• Having a breathing tube placed into the windpipe through the nose or mouth (intubation). The tube must remain in place until the swelling in your or your child's throat has decreased — sometimes for several days.
  
• Inserting a needle into the trachea (needle tracheostomy). In extreme cases or if more conservative measures fail, the doctor may need to create an emergency airway by inserting a needle directly into an area of cartilage in your or your child's trachea. This procedure allows air into your lungs while bypassing the larynx.

Treating infection
If your epiglottitis is related to an infection, intravenous antibiotics will be given once you or your child is getting enough air.

• Broad-spectrum antibiotic. Because of the need for quick treatment, rather than wait for the results of the blood and tissue cultures, you or your child is likely to be treated with a broad-spectrum drug.
  
• More targeted antibiotic. The drug may be changed later, depending on what's causing the epiglottitis.