Epiglottitis

What is Epiglottitis?

An inflammation of the epiglottis is known as epiglottitis. It’s considered a potentially life-threatening condition^1,2. The epiglottis is a leaf-like structure that is found at the superior end within the larynx in a person’s throat. This structure is located at the floor of the tongue and it mostly comprises cartilage tissue. It’s kind of a switch or valve that regulates activities of the esophagus and the larynx or voice box. It works to permit air to gain entry to the airways leading to the lungs. It also permits food and drinks to pass and move to the gastrointestinal tract (GI).

Another function of the epiglottis is to offer protection to the body from things like choking caused by food or other things that would otherwise obstruct the airway.^1,3 The structure prevents food or liquids from reaching the windpipe when a person is eating or drinking.

If there is an infection of epiglottis, it can swell and block the airway. This can be a serious condition that requires prompt medical attention. It should be considered a medical emergency. Epiglottitis has in the past been common in children, however, today, it has become a frequent condition among adults. The illness requires immediate diagnosis and treatment, especially in children because they tend to be vulnerable to complications associated with breathing.^1,2

Causes of Epiglottitis

The commonest cause of epiglottitis is a bacterial infection specifically Haemophilus influenzae type B, which is popularly known as Hib. Bacteria may enter the body of an individual when they breathe it in. If the bacteria infect the epiglottis, they can cause epiglottitis. People can catch Hib through inhalation of the germs that are spread after an infected person sneezes, coughs, or blows their nose.

It is also likely for other bacteria strains to cause the illness including Streptococcus pneumonia and Streptococcus A, B, or C. Streptococcus A strain of bacteria is also responsible for causing other illnesses like strep throat. Being infected with Streptococcus pneumonia may cause conditions like bacterial pneumonia.^1,2,4,6,7

In addition to bacterial causes, there are also other microbes that may bring about epiglottitis. For example, viruses involved in causing chickenpox and singles may also cause epiglottitis. Viruses that cause infections of the respiratory system can as well result in epiglottitis.

It is also possible for fungi to cause the condition for example, the ones that are responsible for causing yeast infection or diaper rash.

Other possible causes of epiglottitis are: ^1,2,4,6,7

• Swallowing foreign objects
• Smoking crack cocaine
• Inhaling chemical substances or having chemical burns
• A burn of the throat from hot foods or steam
• Trauma causing injury to throat for example, a gunshot, stabbing, or accidentally hitting the epiglottis during intubation
• In rare instances, the illness may be caused by insect stings, insect bites, or allergic foods. If you get a sting from a bee when eating raw heavy, you can have the epiglottis swelling.²

Epiglottis can affect anyone, but children are at a greater risk. Children that are younger than 12 months are considered to be more vulnerable to this illness. The reason is because at this age, children are not yet done with having their Hib immunization series. In general, the illness is commonly reported in children who are at the age of 2 to 6. Also, older adults are at risk, especially those who have attained 85 years and above.

Children residing in countries that don’t provide vaccines or where vaccines are not easy to get may also be at risk. Some parents may choose not to immunize their children with Hib vaccine and this puts the kids at risk of developing epiglottitis. It is also found that males tend to suffer the illness more than females and it is not clear why there is this gender difference. People with weakened body immunity tend to be susceptible to suffering from the illness. Having diabetes puts individuals at risk too.

Symptoms of Epiglottitis

While there may be various causes of epiglottitis, the symptoms are similar, but there are some differences seen between children and adults. Kids can have epiglottitis in just a matter of hours, however, in adults, the illness develops slowly, often taking a couple of days.

In children, the epiglottitis symptoms are:^1,2,4,7

• Drooling
• Sore throat
• High fever accompanied by chills
• Restlessness
• Difficulty swallowing
• A hoarse voice
• Breathing through the mouth
• Painful swallowing
• Lessening of the symptoms after the child leans forward or sits upright
• Cough
• Ear pain
• Anxiety
• Refusing to eat

In adults, the symptoms of epiglottitis may present in the following ways: ^1,2,4,7

• Having harsh, noisy breathing – stridor
• Fever
• A severe sore throat
• Difficulty breathing
• Unable to catch breath
• Muffled or raspy voice
• Difficulty swallowing
• Rapid swallow breaths
• Trouble speaking
• Leaning forward to allow breathing

Not treating epiglottitis could lead to blocking of airways completely and it may result in discoloration of the skin because of lack of oxygen. The skin will assume a bluish appearance. If this happens, it should be seen as a highly critical situation needing immediately medical help.

Diagnosis of Epiglottitis

If it is suspected that a patient has epiglottitis, the first thing it to ensure that sufficient oxygen is going to the lungs. A pulse oximeter may be used to give an estimate on the amount of oxygen in blood. If it is found that the oxygen saturation has dipped to extremely lower levels, a child may require help with breathing. The aim is to stabilize the condition before further tests are conducted. A doctor my order for tests and perform a physical exam.

X-ray

A neck or chest X-ray is ordered to examine the region and the epiglottis. The X-ray may show something like a thumbprint within the neck, and this is an indication that the epiglottis is enlarged.

Throat examination

A doctor uses a flexible fiber-optic tube comprising a light that looks down the throat to find out the cause for the symptoms. In the process, a local anesthetic may be applied to reduce discomforts.

Throat or blood culture

A doctor may order throat culture test whereby the epiglottis is wiped using a cotton swab. The fluid and tissue sample obtained with the cotton swab is then taken for laboratory analysis to check for Hib. Also the doctor may order that blood culture is done to find out if bacteremia may have occurred.

In bacteremia, bacteria enter the blood causing a serious bloodstream infection. Sometimes, bacteremia may accompany epiglottitis.

Other lab tests conducted to evaluate a patient for epiglottitis are blood tests to check for inflammation or infection. Arterial blood gas test that measures oxygenation of a person’s blood as well as the severity of airway obstruction may also be done. Immunological tests are conducted to look for antibodies that may point out to the specific virus or bacteria causing epiglottitis.

Proper diagnosis is needed because even with modern technology, it proves difficult to diagnose epiglottitis. In its early stages, the condition may be misdiagnosed as infectious mononucleosis, diphtheria, strep throat, or croup. It is quite easy to confuse a case of epiglottitis for croup.

Clinically, epiglottitis differs from croup in that it progressively worsens over time and there is lack of what is described as barking cough. In croup, the epiglottis is not swollen and appears red or pinkish, but in a case of epiglottitis, the epiglottis is swollen often appearing cherry red.

Treatment for Epiglottitis

When a person is suspected to have epiglottitis, immediate hospitalization should be done because the patient is in danger of having sudden or unpredictable airway closure. A secure breathing should be established. A patient may be prescribed antibiotics. The treatment approach may be as follows:

• First, a doctor should make sure the patient is comfortable by ensuring sufficient oxygen is reaching the lungs. If no respiratory distress is detected, IV fluids may help the patient. It is also important that anxiety is prevented because it can cause acute airway blockage particular in young children.
• If there are signs of airway blockage, laryngoscopy is required. In severe cases a doctor may have to perform a procedure known as cricothyrotomy, which involves cutting the neck and inserting a tube to help with breathing. The tube is placed into the windpipe. This option should however be looked at carefully, and only done if the patient seems to be critically ill or there is near-complete obstruction of airways.
• IV antibiotics can help clean an infection in the epiglottis. It also helps control inflammation.

The prognosis may be good if the illness is diagnosed in advance and proper treatment offered. However, if there is inappropriate diagnosis or misdiagnosis, it can make the prognosis to be poor and there are likelihoods of the patient having prolonged handicap or even death. Epiglottitis can be prevented by ensuring that a child gets immunization against H. influenza type b (Hib).

If there is a child in a family who is aged 4 years and below and who is exposed to an individual infected with H influenza epiglottitis, it is important that all persons in the family are given preventive medications like rifampin to ensure that the illness doesn’t spread. The medication will help to eradicate the bacteria from the bodies of the infected individual, the child, and the members of the family. This helps to prevent a situation like ‘carrier state’ whereby an individual carries the bacteria in their body but they don’t actively become sick. The danger of having carriers of the bacteria is that it can still spread to infect other people.

Reference List

1. Epiglottitis. https://www.healthline.com/health/epiglottitis
2. https://www.emedicinehealth.com/epiglottitis/article_em.htm
3. Epiglottis. http://www.innerbody.com/image_digeov/dige02-new2.html
4. Epiglottitis: Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/epiglottitis/symptoms-causes/syc-20372227
5. Epiglottitis: Diagnosis and Treatment: https://www.mayoclinic.org/diseases-conditions/epiglottitis/diagnosis-treatment/drc-20372231
6. https://www.msdmanuals.com/home/ear,-nose,-and-throat-disorders/mouth-and-throat-disorders/epiglottitis
7. Epiglottitis. https://www.webmd.com/a-to-z-guides/epiglottitis-infection-inflammation#1