Epiglottitis

Inflammation of the Epiglottis, Viral Epiglottitis

What is Epiglottitis?

Epiglottitis is a serious, life threatening bacterial infection of the epiglottis. The epiglottis is the soft tissue flap in the throat that functions as a valve over the trachea, the airway to the lungs. When swallowing, the epiglottis obstructs the trachea and prevents food, fluids, and secretions from entering the lung(s). Emergency medical intervention may be needed to prevent the swollen and inflamed epiglottis from causing total airway obstruction and death from asphyxia.

Epiglottitis predominately strikes children between the ages of two and six, but is occasionally seen in adolescents and adults. Most cases are caused by the bacteria Haemophilus influenzae (not to be confused with the influenza virus).

Epiglottitis signs and symptoms

  • Muffled voice or cry (in croup it is more hoarse).
  • Minimal cough (in croup it is a barking cough).
  • Sore throat.
  • Fever.
  • Hoarseness.
  • Drooling caused by difficulty swallowing saliva.
  • Increasing breathing difficulty.
  • Noisy, high-pitched, squeaky inhalations.
  • Purple skin and nails.
  • Odd head posture. The child tilts the neck back and leans forward with the tongue stuck out and the nostrils flared, trying to inhale more air.

How is it diagnosed?

History: The symptoms escalate over 24 hours and include fever, sore throat, lethargy, difficult swallowing with drooling, a muffled voice, and inspiratory breathing difficulties (stridor).

Physical exam: In the adult, direct fiberoptic visualization of the epiglottis can confirm the diagnosis. In suspected cases of epiglottitis in children, direct examination is neither practical nor safe.

Tests: A lateral x-ray of the neck can show the characteristic swollen epiglottis. Throat cultures are taken in all cases.

How is Epiglottitis treated?

Individuals are admitted to the intensive care unit where they can be observed for signs of airway obstruction. It may be necessary to bypass the swollen epiglottis with a breathing tube (endotracheal intubation) until the swelling subsides. Intravenous antibiotics are given.

Medications

  • Antibiotics to control infection. Continue for a minimum of 10 days.
  • Corticosteroid to reduce inflammation.
Information Brand Generic Label Rating
Ampicillin Oral Principen Ampicillin Off-Label
http://www.nmihi.com/c/co-amoxiclav.html Augmentin Amoxicillin/Clavulanate Off-Label
Bactrim Bactrim Co-trimoxazole On-Label

Activity

Bed rest is necessary until all symptoms disappear. Activities may then be resumed gradually.

Diet

Fluids only (usually intravenous) until the child can swallow. After hospitalization, encourage extra fluids and provide a normal diet.

What might complicate it?

Complications include a blocked airway, which can lead to asphyxia.

Predicted outcome

There is complete resolution of the infection with no after effects.

Alternatives

Strep throat can cause fever, sore throat, and lethargy, but the symptoms of strep throat have a faster onset and there are no breathing difficulties.

Appropriate specialists

Otolaryngologist.

Notify your physician if

  • Your child has symptoms of epiglottitis, especially signs of breathing difficulty. Or call 911. This is an emergency!
  • Your child has had epiglottitis in the past, and symptoms of respiratory infection appear.

Last updated 18 December 2011


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