Epiglottitis, a rare infection of the epiglottis—the small flap of cartilage in the throat that closes upon swallowing to prevent food and liquids from entering the windpipeis a medical emergency. When infected, the epiglottis becomes inflamed and swollen, causing rapidly progressive breathing difficulty, especially in children.
In an attempt to ease breathing, a person with epiglottitis commonly assumes a characteristic posture of leaning forward in a sitting position with the neck extended. Swelling of the epiglottis may lead to complete blockage of the airway within 12 hours of onset, so immediate treatment is necessary.
Hospitalization is necessary so that breathing may be aided by tubes or emergency surgery in the event of complete obstruction of the airway. However, once treatment is initiated, symptoms generally subside within 36 to 48 hours, leaving no permanent damage. Epiglottitis most commonly affects children between the ages of two and eight, but it can occur in adolescents and adults.
What Causes Epiglottitis?
- Bacterial infection causes epiglottitis. The most common cause in children is Haemophilus influenzae type B (HIB), which is highly infectious and may dictate antibiotic treatment of other family members. Streptococcal infection can also cause epiglottitis in both children and adults.
- Adults who have a weakened immune system, such as occurs with leukemia, Hodgkin’s disease, AIDS or chemotherapy treatment for cancer are at higher risk for epiglottitis.
Symptoms of Epiglottitis
- Sore throat
- Increasing difficulty swallowing (dysphagia) or pain upon swallowing
- Drooling and leaning forward to avoid swallowing
- Increasingly muffled speech, difficulty speaking, hoarseness
- Irritability and restlessness
- Emergency symptoms: breathing difficulty, a bluish tinge to the skin (cyanosis), loss of consciousness
- Abnormal breathing sounds (stridor)
- Childhood vaccination against Haemophilus influenzae should be provided.
- Limit exposure to people with contagious respiratory illnesses as much as possible.
- A medication called rifampin may be administered to those exposed to epiglottitis to prevent the disease from spreading.
- Examination of the throat using a tongue depressor or laryngoscope (a special lighted scope) may be performed. Because there is a danger that this may cause an inflamed epiglottis to completely block the airway, such an examination should not be attempted at home.
- Neck x-ray
- Blood and throat cultures
- Complete blood count (CBC)
- Nasolaryngoscopy, a procedure in which the doctor inserts a tiny, lighted tube through the nose to look at structures such as the epiglottis may be performed.
- Hospitalization is necessary to treat epiglottitis. Symptoms may quickly become life-threatening.
- Oxygen may be administered to aid breathing.
- Obstruction of the airway may make it necessary to pass a tube down the throat, through the nose or mouth, to permit breathing.
- A temporary surgical opening in the throat, known as a tracheotomy, may be performed in some cases. In this procedure a small tube is surgically inserted into the throat, allowing the patient to breathe. The tube is removed after symptoms and epiglottal inflammation subside.
- Antibiotics (usually a cephalosporin) are administered intravenously to treat the underlying bacterial infection.
- Fluids may be administered intravenously to prevent dehydration.
- Corticosteroid medications may be given to reduce inflammation of the epiglottis.
When to Call a Doctor
- EMERGENCY Call an ambulance or get to a hospital immediately if you or your child begins to experience swallowing or breathing difficulty, or if your child turns blue or loses consciousness.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media