Epiglottitis

• Alternative Names

  Supraglottitis

• Causes, incidence, and risk factors

  Epiglottitis is a life-threatening disease. The epiglottis is a piece of cartilage at the back of the tongue that closes off the windpipe when swallowing. It keeps food from entering the airways, so you don't cough or choke after swallowing.

  Epiglottitis is swelling of the epiglottis, which leads to breathing problems. Swelling of the epiglottis is usually caused by the bacteria Haemophilus influenzae (H. influenzae), although it may be caused by other bacteria or viruses. Upper respiratory infections can lead to epiglottitis. Medicines or diseases that weaken the immune system can make adults more prone to epiglottitis.

  Epiglottitis is most common in children between 2 and 6 years old. Rarely, epiglottitis can occur in adults, and it may be easily overlooked in such patients.

  The occurrence of epiglottitis has decreased dramatically in the United States since the H. influenzae type B (Hib) vaccine became a routine childhood immunization in the late 1980s.

• Symptoms
  Epiglottitis begins with a high fever and sore throat. Other symptoms may include:

  • Abnormal breathing sounds (stridor)
  • Chills, shaking
  • Cyanosis (blue skin coloring)
  • Drooling
  • Difficulty breathing (patient may need to sit upright and lean slightly forward to breathe)
  • Difficulty swallowing
  • Voice changes (hoarseness)
• Signs and tests

  Epiglottitis is a medical emergency. Seek immediate medical help. Do not use a tongue depressor (tongue blade) to try to examine the throat at home, as this may make the condition worse.

  The health care provider will examine the voice box (larynx) using either a small mirror held against the back of the throat or a viewing tube called a laryngoscope. (See: laryngoscopy) The exam may show a swollen and red epiglottis.

  Tests used to diagnose epiglottitis may include:

  • Blood culture or throat culture -- may show H. influenzae or other bacteria
  • Complete blood count (CBC) -- may show a high number of white blood cells
  • Neck x-rays -- may show a swollen epiglottis
• Treatment

  The patient will be admitted to the hospital, usually an intensive care unit (ICU).

  Treatment may include methods to help the patient breathe, including:

  • Breathing tube (intubation)
  • Moistened (humidified) oxygen

  Other treatments may include:

  • Antibiotics to treat the infection
  • Anti-inflammatory medicines called corticosteroids to decrease throat swelling
  • Fluids given through a vein (by IV)
• Expectations (prognosis)

  Epiglottitis can be a life-threatening emergency. However, with proper treatment, the outcome is usually good.

• Complications

  Spasm may cause the airways to close abruptly. In this case, death follows within minutes.

  The airways may become totally blocked, which could result in death.

• Calling your health care provider

  Call the local emergency number (such as 911) if your child has symptoms of epiglottitis, including sudden breathing difficulties, excessive drooling, and irritability.

• Prevention

  Immunization with the Hib vaccine protects children from epiglottitis.

  The bacterial infection that causes epiglottitis is contagious, so family members should be screened and treated if appropriate.

• References

  Sobol SE. Epiglottitis and croup. Otolaryngol Clin North Am. 2008;41(3):551-566.

  Alcaide ML. Pharyngitis and epiglottitis. Infect Dis Clin North Am. 2007;21(2):449-469.

Review Date: 3/27/2009

Reviewed By: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.