Epiglottitis

1 What is Epiglottitis?

Epiglottitis is the inflammation of the epiglottis, the elastic cartilage that covers the windpipe (trachea) during swallowing. The epiglottis performs a vital function of sealing the windpipe, and the entire airway so that food will not enter and cause a blockage. 

Epiglottitis can occur at any age. Because it involves the airways, epiglottitis is potentially life-threatening if not treated immediately. It can block the airways and prevent breathing. Treatment prevents complications and does not cause problems in long-term.

The epiglottis can become inflamed due several factors such as burns from swallowing hot liquids, throat injuries and infection caused by Haemophilus influenzae type-B (Hib). 

Most children today receive vaccination for HiB, which also happen to cause serious pneumonia, meningitis and blood infections. Therefore, epiglottitis caused by infections are particularly rare. 

2 Symptoms

Epiglottitis in children may cause symptoms within hours. In children, epiglottitis may cause the following:

  • A severe sore throat, sometimes with fever
  • High pitched sound emitted during breathing (stridor)
  • Swallowing is difficult and painful
  • Anxiousness and restlessness
  • Drooling
  • Child becomes more comfortable when sitting up and leaning forward

Adults tend to develop symptoms slowly, sometimes for several days:

  • A severe sore throat
  • Fever
  • Hoarseness or muffled voice
  • Stridor
  • Difficulty breathing and swallowing
  • Drooling

Epiglottitis is a medical emergency, and a person with any of these symptoms must be brought to the nearest hospital immediately. Make the person or child sit upright and keep him or her quiet to avoid closure of the airways. 

Unless done by a doctor, examination of the throat by anyone is strongly discouraged because it might cause the inflamed epiglottis to close the airways and restrict breathing. 

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3 Causes

Epiglottitis can be caused by a number of factors, such as infection or exposure to hot liquids.

Injuries or infection of the epiglottis can make it swell. 

Injuries

Direct blows to the throat, drinking very hot or caustic liquids (like in the case of poisoning) can cause epiglottitis. There are injuries that also cause problem similar to epiglottitis:

  • Swallowing foreign objects
  • Smoking drugs like crack cocaine 
  • Ingestion of chemicals that burn the throat, like many liquid poisons 

Infection

Epiglottis can have an infection that results in swelling and inflammation. The most common culprit is Haemophilus influenzae (HiB) bacteria, which can also cause deadly childhood meningitis and pneumonia

This bacteria is transmissible through airborne droplets emitted when coughing or sneezing, and can reside in the noses and mouths of healthy individuals without causing any sickness.

Due to widespread immunization in children, HiB infection is becoming rare. However, there are other microorganisms can cause epiglottitis:

  • Streptococcus pneumoniae (pneumococcus) is a bacteria that can also cause meningitis, pneumonia, septicemia (infection of the blood) and ear infections
  • Streptococcus A, B, and C is a group of bacteria that causes strep throat and septicemia

4 Making a Diagnosis

Making a diagnosis of epiglottitis is done by performing several tests.

Epiglottitis is a medical emergency, so it highly unlikely for you to do preparations. In the emergency room, doctors’ first priority is to keep the airways open and monitor oxygen levels in the bloodstream. 

A device called a pulse oximeter is clipped on the patient’s finger. This device gives the doctor information regarding oxygen levels in the blood. If oxygen levels start to drop, the health team may start procedures to help the patient breathe.

Once the patient’s breathing is stabilized and oxygen levels return to normal, the doctor may order the following tests:

  • Throat examination using a flexible fiber-optic tube with light and lens on the other end, which is inserted to visualize the structures of the throat and see what is causing symptoms. The doctor may give a small dose of local anesthetic to relieve any discomfort.
  • X-rays on the chest and throat can reveal swollen epiglottis or presence of foreign objects in the airways that can cause symptoms, but can only be done after the airways are protected. 
  • Throat culture and blood tests can reveal bacteria that caused epiglottitis, and if the bloodstream has an infection as well. Throat culture only requires wiping the epiglottis with a cotton swab, which is then examined in a laboratory.

5 Treatment

The first priority in treating epiglottitis is keeping the airways open. Doctors may do the following to stabilize breathing:

  • Placing an oxygen mask 
  • Intubation, or inserting a tube in your airways passing the throat, so the airways remain open even if there is swelling. Intubation is done in a short procedure. 
  • In very urgent cases, or if intubation fails to open airways, the doctor creates another airway by inserting a hollow needle into a cartilaginous area in the trachea. This allows air to bypass the larynx and go directly to the lungs.

If infection is present, the doctor may prescribe the following drugs:

  • A broad-spectrum antibiotic, which kills a wide range of bacteria including those that cause infection. It is often given before the results of blood tests, and throat cultures are available. 
  • A more targeted antibiotic may replace the first antibiotic once the cause of infection has been recognized.

6 Prevention

Epiglottitis can be easily prevented by keeping you or your child safe from infections. Do this by avoiding sharing of personal items and avoiding large groups of people, especially during cold season. Wash hands frequently or use alcohol-based hand sanitizer. 

Vaccination can greatly reduce chances of having epiglottitis caused by HiB, as well as other serious childhood illnesses. HiB vaccine is given to infants in the following schedule:

  • At 2 months of age
  • At 4 months
  • At 6 months, if the child is being given the four-dose vaccine
  • At 12 months and at 15 months

HiB vaccine may cause minor side effects such as redness, warmth, swelling or pain at the injection site. Allergic reactions are possible and must be treated immediately. Symptoms of allergic reaction include wheezing, hives, difficulty breathing, rapid heartbeat and weakness moments or few hours after vaccine injection.

HiB vaccine is not usually given to children above 5 years of age and to adults because they are much less vulnerable and less likely to have HiB infection. However, HiB vaccine may be given to individuals with weakened immune systems. 

The U.S. Centers for Disease Control and Prevention recommends giving HiB vaccine to individuals with the following conditions:

  • HIV/AIDS
  • Sickle cell disease
  • Those who underwent spleen removal operation
  • Those who underwent chemotherapy
  • Those who are taking medications to prevent organ rejection after bone or organ transplants

7 Risks and Complications

There are several risks and complications associated with epiglottitis.

Epiglottitis tends to affect more individuals with the following:

  • Males
  • Delayed or skipped vaccination, which is a risk factor for Haemophilus influenzae infection
  • Having a weak immune system due to illnesses or use of certain medications

Epiglottitis can cause serious complications. The swollen epiglottis can close the airways entirely and cause respiratory failure, resulting in very low oxygen levels in the blood. The bacteria in the epiglottis can also spread elsewhere parts in the body and cause pneumonia, meningitis or septicemia.

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