Epiglottitis is a potentially life-threatening situation. It can block the flow of air into the lungs. epiglottitis usually begins with inflammation between the base of the tongue and epiglottis.
Epiglottitis was first described in the 18th century but accurately described in 1936 by Le Mierre.
It is an acute inflammation of the epiglottis and adjacent supraglottic structures.
The infection causes edema of the supraglottic airway that results in airway narrowing and curling of the epiglottis into the airway which can be potentially dangerous.
Potentially life-threatening infection that can cause fatal airway obstruction and cardiorespiratory arrest if treatment is delayed.
Historically epiglottitis is caused by Haemophilus influenzae type B (HIB); however, since the initiation of the HIB vaccination, epiglottitis has become quite rare.
- HIB is still the most common cause of epiglottitis
- unvaccinated children
- immunocompromised state and
- trisomy 21
Additional causes of the epiglottitis
Several other causative organisms have been identified: H. influenzae (A, F, and non-typeable), H. parainfluenzae, S. pneumonia, and S. aureus
There may also be viral etiologies.
Most common in children 2 to 7 years of age; may also occur in adolescents and adult
Rapid onset of high fever, toxic appearance, muffled voice, and sore throat
Symptoms progress over a few hours to dysphagia, drooling, and respiratory distress
Respiratory failure secondary to airway obstruction can occur very rapidly after initial presentation.
Stridor is often a late finding and, when present, is indicative of near-complete airway obstruction
Cough is not a prominent symptom, if present, is minimal.
The child may sit in the “tripod” position, leaning forward with a hyperextended neck to promote airway opening.
Diagnosis and Evaluation
Clinical diagnosis is critical because time is of the essence to maintain airway patency
A lateral neck radiograph should be attempted only if the patient is stable and the diagnosis is in doubt
Direct laryngoscopy confirms the diagnosis; however, this should be attempted only in a controlled setting by an experienced airway practitioner (ENT or anesthesiology)
Treatment of epiglottitis
Avoid causing the child to have anxiety or agitation because they can promote airway closure.
100% oxygen should be provided via blow-by.
Intubation should be performed in the most controlled environment .
If unable to intubate, an emergent tracheostomy should be performed.
Administration of IV antibiotics to cover both HIB and streptococcus (third-generation cephalosporins are most commonly used)