Epiglottitis
Epiglottitis
Definition
Epiglottitis is an infection of the epiglottis, which can lead to severe airway obstruction.
Description
When air is inhaled (inspired), it passes through the nose and the nasopharynx or through the mouth and the oropharynx. These are both connected to the larynx, a tube made of cartilage. The air continues down the larynx to the trachea. The trachea then splits into two branches, the left and right bronchi (bronchial tubes). These bronchi branch into smaller air tubes that run within the lungs, leading to the small air sacs of the lungs (alveoli).
Either food, liquid, or air may be taken in through the mouth. While air goes into the larynx and the respiratory system, food and liquid are directed into the tube leading to the stomach, the esophagus. Because food or liquid in the bronchial tubes or lungs could cause a blockage or lead to an infection, the airway is protected. The epiglottis is a leaf-like piece of cartilage extending upwards from the larynx. The epiglottis can close down over the larynx when someone is eating or drinking, preventing these food and liquids from entering the airway.
Epiglottitis is an infection and inflammation of the epiglottis. Because the epiglottis may swell considerably, there is a danger that the airway will be blocked off by the very structure designed to protect it. Air is then unable to reach the lungs. Without intervention, epiglottitis has the potential to be fatal.
Epiglottitis is primarily a disease of two to seven-year-old children, although older children and adults can also contract it. Boys are twice as likely as girls to develop this infection. Because epiglottitis involves swelling and infection of tissues, which are all located at or above the level of the epiglottis, it is sometimes referred to as supraglottitis (supra, meaning above). About 25% of all children with this infection also have pneumonia.
Causes and symptoms
The most common cause of epiglottitis is infection with the bacteria called Haemophilus influenzae type b. Other types of bacteria are also occasionally responsible for this infection, including some types of Streptococcus bacteria and the bacteria responsible for causing diphtheria.
A patient with epiglottitis typically experiences a sudden fever, and begins having severe throat and neck pain. Because the swollen epiglottis interferes significantly with air movement, every breath creates a loud, harsh, high-pitched sound referred to as stridor. Because the vocal cords are located in the larynx just below the area of the epiglottis, the swollen epiglottis makes the patient's voice sound muffled and strained. Swallowing becomes difficult, and the patient may drool. The patient often leans forward and juts out his or her jaw, while struggling for breath.
Epiglottitis strikes suddenly and progresses quickly. A child may begin complaining of a sore throat, and within a few hours be suffering from extremely severe airway obstruction.
Diagnosis
Diagnosis begins with a high level of suspicion that a quickly progressing illness with fever, sore throat, and airway obstruction is very likely to be epiglottitis. If epiglottitis is suspected, no efforts should be made to look at the throat, or to swab the throat in order to obtain a culture for identification of the causative organism. These maneuvers may cause the larynx to go into spasm (laryngospasm), completely closing the airway. These procedures should only be performed in a fully-equipped operating room, so that if laryngospasm occurs, a breathing tube can be immediately placed in order to keep the airway open.
An instrument called a laryngoscope is often used in the operating room to view the epiglottis, which will appear cherry-red and quite swollen. An x-ray picture taken from the side of the neck should also be obtained. The swollen epiglottis has a characteristic appearance, called the "thumb sign."
Treatment
Treatment almost always involves the immediate establishment of an artificial airway: inserting a breathing tube into the throat (intubation); or making a tiny opening toward the base of the neck and putting a breathing tube into the trachea (tracheostomy). Because the patient's apparent level of distress may not match the actual severity of the situation, and because the disease's progression can be quite surprisingly rapid, it is preferable to go ahead and place the artificial airway, rather than adopting a wait-and-see approach.
Because epiglottitis is caused by a bacteria, antibiotics such as cefotaxime, ceftriaxone, or ampicillin with sulbactam should be given through a needle placed in a vein (intravenously). This prevents the bacteria that are circulating throughout the bloodstream from causing infection elsewhere in the body.
Prognosis
With treatment (including the establishment of an artificial airway), only about 1% of children with epiglottitis die. Without the artificial airway, this figure jumps to 6%. Most patients recover form the infection, and can have the breathing tube removed (extubation) within a few days.
Prevention
Prevention involves the use of a vaccine against H. influenzae type b (called the Hib vaccine). It is given to babies at two, four, six, and 15 months. Use of this vaccine has made epiglottitis a very rare occurrence.
Resources
ORGANIZATIONS
American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince St., Alexandria VA 22314-3357. (703) 836-4444. 〈http://www.entnet.org〉.
KEY TERMS
Epiglottis— A leaf-like piece of cartilage extending upwards from the larynx, which can close like a lid over the trachea to prevent the airway from receiving any food or liquid being swallowed.
Extubation— Removal of a breathing tube.
Intubation— Putting a breathing tube into the airway.
Laryngospasm— Spasm of the larynx.
Larynx— The part of the airway lying between the pharynx and the trachea.
Nasopharynx— The part of the airway into which the nose leads.
Oropharynx— The part of the airway into which the mouth leads.
Supraglottitis— Another term for epiglottitis.
Trachea— The part of the airway that leads into the bronchial tubes.
Tracheostomy— A procedure in which a small opening is made in the neck and into the trachea. A breathing tube is then placed through this opening.
Epiglottitis
Epiglottitis
What Are the Signs and Symptoms of Epiglottitis?
How Do Doctors Diagnose and Treat Epiglottitis?
How Long Does It Take to Recover from Epiglottitis?
Can Epiglottitis Be Prevented?
Epiglottitis (eh-pih-glah-TIE-tis) is a condition involving life-threatening swelling of the epiglottis*. It is usually caused by a bacterial infection of the epiglottis and can result in a blockage of the trachea (windpipe) and severe breathing difficulty.
- *epiglottis
- (eh-pih-GLAH-tis) is a soft flap of tissue that covers the opening of the trachea (wind-pipe) when a person swallows to prevent food or fluid from entering the airway and lungs.
KEYWORDS
for searching the Internet and other reference sources
Epiglottis
Haemophilus influenzae bacteria
Upper airway obstruction
What Is Epiglottitis?
Epiglottitis, also known as supraglottitis (su-pra-glah-TIE-tis), is characterized by inflammation and swelling of the epiglottis and other upper airway structures. The epiglottis can become dangerously swollen within just a few hours, leading to narrowing of the airway and severe breathing difficulty.
Epiglottitis is usually caused by bacterial infection. Haemophilus influenzae type B (Hib) bacteria accounted for the majority of epiglottitis cases before the widespread use of the Hib vaccine. Staphylococcus aureus ; Streptococcus pneumoniae and group A, B, and C streptococci bacteria; certain viruses; traumatic injuries; scalding; and severe smoke inhalation (causing burns in the upper airway) can also lead to epiglottitis.
Who Gets Epiglottitis?
Epiglottitis is most common in children under 7 years of age. In the United States, cases of epiglottitis have declined greatly since the Hib vaccine was introduced in 1985.
Epiglottitis itself is not contagious, but the bacterial infections that can lead to the condition are. This means the bacteria can spread through
Bacterial infection may cause inflammation and swelling of the epiglottis, which can quickly bring about narrowing or even closing of the airway and severe breathing problems.
person-to-person contact, often in drops of moisture from the respiratory tract when someone sneezes, coughs, or breathes.
What Are the Signs and Symptoms of Epiglottitis?
Epiglottitis often begins with a sore throat. Symptoms may come on suddenly and include:
- high fever
- inability to swallow and drooling
- difficulty breathing
- muffled voice
- stridor (STRY-dor, a high-pitched, squeaking noise that occurs while breathing in; it is present usually only if there is narrowing or blockage of the upper airway)
- a “sniffing” posture (when a young child leans forward, with chin extended, to make it easier to breathe)
Because their airways are smaller than those of adults, children with epiglottitis are at higher risk for developing severe breathing problems.
How Do Doctors Diagnose and Treat Epiglottitis?
Epiglottitis is a medical emergency that must be treated in a hospital. Ensuring that the person is able to breathe is the first and most important concern. Often a procedure called intubation (in-too-BAY-shun) is
Normal airways allow the free flow of air through the nose and mouth past the epiglottis, and then into the lungs.
performed, in which a tube is inserted into the windpipe through the mouth or nose to ensure that air can continue to flow into the lungs. In some cases, an emergency tracheostomy* must be performed to bypass the blocked part of the person’s airway.
- *tracheostomy
- (tray-kee-AHS-tuhme) refers to a small opening through the neck into the trachea, or windpipe, which has been made to allow air to enter the lungs more directly. The surgical procedure to create a tracheostomy is usually performed when a person’s upper airway is narrowed or blocked or when there are other problems causing breathing difficulty.
Doctors usually diagnose epiglottitis based on a physical examination and the patient’s medical history. If the diagnosis is not clear, a doctor may order an X ray of the neck that will show if the epiglottis is swollen. Blood cultures or other blood tests may be used to confirm that the person has a bacterial or viral infection.
Intravenous* (IV) antibiotics are usually given to combat the infection that led to epiglottitis. Corticosteroid* medication is sometimes given to further reduce the swelling of the upper airway so the person can breathe more easily.
- *intravenous
- (in-tra-VEE-nus) (IV) means within or through a vein. For example, medications, fluid, or other substances can be given through a needle or soft tube inserted through the skin’s surface directly into a vein.
- *corticosteroids
- (kor-tih-ko-STIR-oyds) are chemical substances made by the adrenal glands that have several functions in the body, including maintaining blood pressure during stress and controlling inflammation. They can also be given to people as medication to treat certain illnesses.
How Long Does It Take to Recover from Epiglottitis?
People with epiglottitis are hospitalized, usually in intensive care, for several days to a week or more to manage the infection that led to epiglottitis. The time it takes to fully recover varies depending on the particular infection.
Possible complications of epiglottitis include pneumonia*, ear infection and, rarely, meningitis* or bacteremia* caused by the same microorganism that caused the epiglottitis.
- *pneumonia
- (nu-MO-nyah) is inflammation of the lung.
- *meningitis
- (meh-nin-JY-tis) is an inflammation of the meninges, the membranes that surround the brain and the spinal cord. Meningitis is most often caused by infection with a virus or a bacterium.
- *bacteremia
- (bak-tuh-REE-me-uh) is the presence of bacteria in the blood.
If not treated quickly, epiglottitis can result in complete airway obstruction (air can no longer flow into the lungs) and death.
Can Epiglottitis Be Prevented?
The best way to prevent epiglottitis is to avoid infection by the bacteria that most commonly cause it. The Hib vaccine, which is part of the routine childhood immunization schedule in the United States, has been extremely successful in decreasing the number of cases of epiglottitis resulting from H. influenzae infection. The Hib vaccine is given as four separate injections (shots) before 2 years of age.
See also
Staphylococcal Infections
Streptococcal Infections
Vaccination (Immunization)
Resources
Organization
The U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894. A search of the National Library of Medicine website provides information about epiglottitis and the Hib vaccine. Telephone 888-346-3656 http://www.nlm.nih.gov
Website
KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including Hib immunization information.
Epiglottitis
Epiglottitis
Definition
Epiglottitis is an infection of the epiglottis, which can lead to severe airway obstruction.
Description
When air is inhaled (inspired), it passes through the nose and the nasopharynx or through the mouth and the oropharynx. These are both connected to the larynx, a tube made of cartilage. The air continues down the larynx to the trachea. The trachea then splits into two branches, the left and right bronchi (bronchial tubes). These bronchi branch into smaller air tubes that run within the lungs, leading to the small air sacs of the lungs (alveoli).
Either food, liquid, or air may be taken in through the mouth. While air goes into the larynx and the respiratory system, food and liquid are directed into the tube leading to the stomach, the esophagus. Because food or liquid in the bronchial tubes or lungs could cause a blockage or lead to an infection, the airway is protected. The epiglottis is a leaf-like piece of cartilage extending upwards from the larynx. The epiglottis can close down over the larynx when someone is eating or drinking, preventing these food and liquids from entering the airway.
Epiglottitis is an infection and inflammation of the epiglottis. Because the epiglottis may swell considerably, there is a danger that the airway will be blocked off by the very structure designed to protect it. Air is then unable to reach the lungs. Without intervention, epiglottitis has the potential of being fatal. Because epiglottitis involves swelling and infection of tissues, which are all located at or above the level of the epiglottis, it is sometimes referred to as supraglottitis (supra meaning above). About 25 percent of all children with this infection also have pneumonia .
Demographics
In the twentieth century, epiglottitis was primarily a disease of two- to seven-year-old children, with boys twice as likely to become ill as girls. In the early 2000s vaccines have greatly reduced the incidence of Haemophilus influenzae type b (Hib) epiglottitis, and the disease is more frequently seen in adults. In children, epiglottitis is an incredibly rare disease, thanks to timely Hib vaccination in childhood.
Causes and symptoms
The most common cause of epiglottitis is infection with the bacteria called Haemophilus influenzae type b. Other types of bacteria are also occasionally responsible for this infection, including some types of Streptococcus bacteria and the bacteria responsible for causing diphtheria .
A patient with epiglottitis typically experiences a sudden fever and begins having severe throat and neck pain . Because the swollen epiglottis interferes significantly with air movement, every breath creates a loud, harsh, high-pitched sound referred to as stridor . Because the vocal cords are located in the larynx just below the area of the epiglottis, the swollen epiglottis makes the patient's voice sound muffled and strained. Swallowing becomes difficult, and the patient may drool. The patient often leans forward and juts out his or her jaw, while struggling for breath.
Epiglottitis strikes suddenly and progresses quickly. A child may begin complaining of a sore throat and within a few hours be suffering from extremely severe airway obstruction.
Diagnosis
Diagnosis begins with a high level of suspicion that a quickly progressing illness with fever, sore throat, and airway obstruction is very likely to be epiglottitis. If epiglottitis is suspected, no efforts should be made to look at the throat or to swab the throat in order to obtain a culture for identification of the causative organism. These maneuvers may cause the larynx to go into spasm (laryngospasm), completely closing the airway. These procedures should only be performed in a fully equipped operating room, so that if laryngospasm occurs, a breathing tube can be immediately placed in order to keep the airway open.
An instrument called a laryngoscope is often used in the operating room to view the epiglottis, which will appear cherry-red and quite swollen. An x ray picture taken from the side of the neck should also be obtained. The swollen epiglottis has a characteristic appearance, called the "thumb sign."
Treatment
Treatment almost always involves the immediate establishment of an artificial airway: inserting a breathing tube into the throat (intubation) or making a tiny opening toward the base of the neck and putting a breathing tube into the trachea (tracheostomy). Because the patient's apparent level of distress may not match the actual severity of the situation, and because the disease's progression can be quite surprisingly rapid, it is preferable to go ahead and place the artificial airway, rather than adopting a wait-and-see approach.
Because epiglottitis is caused by a bacteria, antibiotics such as cefotaxime, ceftriaxone, or ampicillin with sulbactam should be given through a needle placed in a vein (intravenously). This prevents the bacteria that are circulating throughout the bloodstream from causing infection elsewhere in the body.
KEY TERMS
Epiglottis —A leaf-like piece of cartilage extending upwards from the larynx, which can close like a lid over the trachea to prevent the airway from receiving any food or liquid being swallowed.
Extubation —The removal of a breathing tube.
Intubation —A procedure in which a tube is inserted through the mouth and into the trachea to keep the airway open and to help a patient breathe.
Laryngospasm —Spasmodic closure of the larynx.
Larynx —Also known as the voice box, the larynx is the part of the airway that lies between the pharynx and the trachea. It is composed of cartilage that contains the apparatus for voice production–the vocal cords and the muscles and ligaments that move the cords.
Nasopharynx —One of the three regions of the pharynx, the nasopharynx is the region behind the nasal cavity.
Oropharynx —One of the three regions of the pharynx, the oropharynx is the region behind the mouth.
Supraglottitis —Another term for epiglottitis.
Trachea —The windpipe. A tube composed of cartilage and membrane that extends from below the voice box into the chest where it splits into two branches, the bronchi, that lead to each lung.
Tracheostomy —A procedure in which a small opening is made in the neck and into the trachea or windpipe. A breathing tube is then placed through this opening.
Prognosis
With treatment (including the establishment of an artificial airway), only about 1 percent of children with epiglottitis die. Without the artificial airway, this figure jumps to 6 percent. Most patients recover from the infection and can have the breathing tube removed (extubation) within a few days.
Prevention
Prevention involves the use of a vaccine against H. influenzae type b (called the Hib vaccine ). It is given to babies at two, four, six, and 15 months. Use of this vaccine has made epiglottitis a very rare occurrence.
Parental concerns
Parents should be aware of the advantages of the Hib vaccine. They should also call the doctor immediately if a child has a sudden, high fever and neck or throat pain.
Resources
BOOKS
Long, Sarah S., et al, eds. Principles and Practice of Pediatric Infectious Diseases, 2nd ed. St. Louis, MO: Elsevier, 2003.
Roosevelt, Genie E. "Acute Inflammatory Upper Airway Obstruction." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.
ORGANIZATIONS
American Academy of Otolaryngology-Head and Neck Surgery Inc. One Prince St., Alexandria VA 22314–3357. Web site: <www.entnet.org>.
Rosalyn Carson-DeWitt, MD