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Alternative Name: Supraglottitis
Epiglottitis is an inflammation of the epiglottis – the flap that sits at the base of the tongue, which keeps food from going into the trachea (windpipe). Due to its place in the airway, swelling of this structure can interfere with breathing and constitutes a medical emergency. The infection can cause the epiglottis to either obstruct or completely close off the windpipe.
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Epiglottitis tends to occur in children aged between two and seven years old, and is rare in adults, although it may occur at any age. In the UK it is no longer common, following the introduction of a vaccine to protect against Hib.
With the advent of the Hib vaccine, the incidence has been reduced, but the condition has not been eliminated. If you suspect that you or someone in your family has epiglottitis, seek emergency help immediately. Prompt treatment can prevent life-threatening complications of epiglottitis.
Symptoms in children
In children, signs and symptoms of epiglottitis may develop within a matter of hours, including:
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*Severe sore throat
*Difficult and painful swallowing
*Drooling due to severe pain when swallowing
*Anxious, restless behavior
*Greater comfort when sitting up or leaning forward
Symptoms in adults
For adults, signs and symptoms may develop more slowly, over days rather than hours. Signs and symptoms may include:
*Severe sore throat
*A muffled or hoarse voice
*Harsh, raspy breathing
Cases in adults are most typically seen amongst abusers of crack cocaine and have a more subacute presentation. George Washington is thought to have died of epiglottitis.
Epiglottitis is caused by an infection or an injury.
A common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection with Haemophilus influenzae type b (Hib) bacteria. Hib isn’t the germ that causes the flu, but it’s responsible for other serious conditions — including respiratory tract infections and meningitis.
Hib spreads through infected droplets coughed or sneezed into the air. It’s possible to harbor Hib in your nose and throat without becoming sick — though you still have the potential to spread the bacteria to others.
Other bacteria and viruses also can cause inflammation of the epiglottis, including:
*Streptococcus pneumoniae (pneumococcus), another bacterium that causes meningitis, pneumonia, ear infections and blood infection (septicemia)
*Streptococcus A, B and C, a group of bacteria that cause diseases ranging from strep throat to blood infections.
*Candida albicans, the fungus responsible for vaginal
yeast infections, diaper rash and oral thrush
*Varicella zoster, the virus responsible for chickenpox and shingles
Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can burns from drinking very hot liquids.
You also may develop signs and symptoms similar to those of epiglottitis if you:
*Swallow a chemical that burns your throat
*Swallow a foreign object
*Smoke drugs, such as crack cocaine
Certain factors increase the risk of developing epiglottitis, including:
*Sex. Epiglottitis affects more males than females.
*Weak immune system. If your immune system has been weakened by illness or medication, you’re more susceptible to the bacterial infections that may cause epiglottitis.
*Inadequate vaccination. Delayed or skipped immunizations can leave a child vulnerable to Hib and increases the risk of epiglottitis.
*Spasm may cause the airways to close abruptly. In this case, death follows within minutes.
*Some patients may develop pneumonia, lymphadenopathy or septic arthritis.
*The airways may become totally blocked, which could result in death.
Diagnosis is confirmed by direct inspection using laryngoscopy, although this may provoke airway spasm. If it is suspected, attempts to visualise the epiglottis using a tongue depressor are STRONGLY discouraged for this reason. A paediatric, anaesthesia or ENT specialist should be alerted immediately. Imaging is rarely useful, and treatment should not be delayed for this test to be carried out.
The epiglottis and arytenoids are cherry-red and swollen. The most likely differential diagnostic candidates are croup, peritonsillar abscess, and retropharyngeal abscess.
On lateral C-spine X-ray, the thumbprint sign (or just “thumb sign”) describes a swollen enlarged epiglottis.
Epiglottitis may require urgent tracheal intubation to protect the airway, though this is not always the case. In some cases, epiglottitis requires the use of antibiotics while a patient is experiencing the benefits of a breathing tube. In more serious cases, tracheal intubation is necessary. In such cases, it is not advised to immediately head in the direction of intubation because the inflammed epiglottis is very sensitive and if you irritate the epiglottis with the laryngoscope you can cause the epiglottis to close off completely forcing the use of a surgical airway (cricothyrotomy). Most children can be managed by letting the child be in a position of comfort, keep the lights down low and keep the child calm. Intubation is a good thing to have in the back of your mind and it may become necessary if the child starts to rapidly decompensate and show signs of impending respiratory arrest (decreased work of breathing with abnormal skin signs) given in the initial stages to reduce symptoms, but this will not treat the underlying cause. It should also be noted that if stridor becomes quieter, obstruction is likely to follow, and thus intubation should be expedited even further.
In addition, patients should be given antibiotic such as second- or third generation cephalosporins (either alone or in combination with penicillin or ampicillin for streptococcal coverage).
Prognosis: Epiglottitis can be a life-threatening emergency. However, with proper treatment, the outcome is usually good.
Immunization with the Hib vaccine is an effective way to prevent epiglottitis caused by Hib. In the United States, children usually receive the vaccine in three or four doses:
*At 2 months
*At 4 months
*At 6 months if your child is being given the four-dose vaccine
*At 12 to 15 months
The Hib vaccine is generally not given to children older than age 5 or to adults because they’re less likely to develop Hib infection. But the Centers for Disease Control and Prevention recommends the vaccine for older children and adults whose immune systems have been weakened by:
*Sickle cell disease
*Medications to prevent rejection of organ or bone marrow transplants
Vaccine side effects
Possible side effects of the Hib vaccine include redness, warmth or swelling at the injection site, and a fever. Rarely, a serious allergic reaction may cause difficulty breathing, wheezing, hives, weakness, a rapid heartbeat or dizziness within minutes or a few hours after the shot. If you have an allergic reaction to the vaccine, seek medical help immediately.
Common-sense precautions :
Of course, the Hib vaccine doesn’t offer guarantees. Immunized children have been known to develop epiglottitis — and other germs can cause epiglottitis, too. That’s where common-sense precautions come in:
*Don’t share personal items.
*Wash your hands frequently.
*Use an alcohol-based hand sanitizer if soap and water aren’t available.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
- An Overview of Epiglottitis in Children (brighthub.com)
- Calling Epiglottitis A Bitch Is A Vast Understatement (hibernationnow.wordpress.com)
- Croup (findmeacure.com)
- What Causes Laryngitis? (brighthub.com)
- My tongue is swollen and hurts. How do i help the pain? (zocdoc.com)
- Scrutinized in Japan, Pfizer’s Prevnar Vaccine is Used Widely in U.S. (blogs.wsj.com)
- Pfizer, Sanofi-Aventis Vaccines Suspended in Japan (dailyfinance.com)
- What Are the Signs and Symptoms of Throat Cancer? (brighthub.com)