Epiglottitis

Epiglottitis is a medical emergency that may result in death if not treated quickly. The epiglottis is a flap of tissue that sits at the base of the tongue that keeps food from going into the trachea, or windpipe, during swallowing. When it gets infected and inflamed, it can obstruct, or close off, the windpipe, which may be fatal unless promptly treated.

Acute epiglottitis is an inflammation of the epiglottis that tends to cause airway obstruction. It typically strikes children ages 2 to 8. A critical emergency, epiglottitis can prove fatal in 8% to 12% of victims unless it's recognized and treated promptly.

Causes

Epiglottitis usually results from infection with the bacterium Haemophilus injluenzae type B; occasionally, it results from pneumococci and group A streptococci.

Signs and symptoms

Symptoms usually appear suddenly, with a high fever and a very sore throat, which causes the child to drool saliva as it's too painful to swallow or even speak. Breathing is noisy and becomes increasingly difficult over a matter of hours. The tongue and lips may look blue.

The child looks ill and will sit upright with their mouth open to help breathing. There's minimal or no coughing (unlike viral croup, it can be difficult to tell the difference between epiglottitis and croup, but they require different treatments).

Diagnosis

In acute epiglottitis, throat examination reveals a large, edematous, bright red epiglottis. Such examination should follow lateral neck X-rays and, generally, should not be performed if the suspected obstruction is large.

Treatment

A child with acute epiglottitis and airway obstruction requires emergency hospitalization; he may need emergency ET intubation or a tracheotomy and should be monitored in an intensive care unit. Respiratory distress that interferes with swallowing necessitates parenteral fluid administration to prevent dehydration.

A patient with acute epiglottitis should always receive a 10-day course of parenteral antibiotics-usually a second- or third-generation cephalosporin (if the child is allergic to penicillin, a quinolone or sulfa drug may be substituted). Oxygen therapy and arterial blood gas (ABG) monitoring may be desirable.

Prevention

Immunization with the Hib vaccine is the most effective way to prevent epiglottitis in children younger than age 5. In the United States, children usually receive the vaccine in four doses: at ages 2 months, 4 months, 6 months and 12 to 15 months.

The bacterial infection that causes epiglottitis is contagious, so family members should be screened and treated if appropriate. Have your children immunized with the Hib vaccine.

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