Epiglottitis Diagnosis

  • Diagnosis

    Epiglottitis is inflammation of the epiglottis, the flap at the bottom of the throat that closes the entrance to the voice box and the windpipe Figure 01. The epiglottis normally remains in an open position to allow air to enter the windpipe. When you swallow, the epiglottis closes this entrance, preventing food or liquids from entering the airway. When infected with bacteria or a virus, the epiglottis may become sore, red, and swollen.

    Click to enlarge: The epiglottis (animation)

    Figure 01. The epiglottis (animation)

    Epiglottitis develops rapidly, and can be life threatening if not treated quickly. Epiglottitis develops rapidly, and is potentially more lethal than any other upper respiratory tract infection. When the epiglottis becomes inflamed and swollen, it obstructs the airway, and may close it off completely. Epiglottitis is an emergency situation because it can progress from a sore throat to complete airway obstruction in only a matter of hours. If you suspect that you or your child has epiglottitis, it is essential to get medical attention immediately.

    Epiglottitis is most common among young children, but it can affect people of all ages. Epiglottitis is most common among children between two and seven years of age, and occurs more frequently in boys than girls. However, epiglottitis can occur in children under the age of two, and in adults as well. The disease progresses more slowly in adults than in children, presumably because of the larger diameter of the adult airway.

    Epiglottitis is almost always caused by a bacterial infection. Epiglottitis is most often caused by an infection with Haemophilus influenzae type b.H. influenzaeis a common bacterium, and is also a leading cause of meningitis, pneumonia, ear infections, and sinus infections. Despite its name,H. influenzaedoes not cause the flu; it was mistakenly identified as a flu organism during the 1889 influenza pandemic.

    Epiglottitis caused byH. influenzae type b infection is less frequent now than in the past because the H. influenzae type b (HIB) vaccine is a routine part of early childhood immunization programs. As a result, epiglottitis most commonly occurs in children who have not received the vaccine.

    Infection with H. influenzae type b also causes pneumonia; in about 25% of cases, epiglottitis and pneumonia will occur at the same time. The infection may also spread to the joints, the linings of the brain, the tissue that surrounds the heart cavity, and the tissues under the skin. Infection of the blood (bacteremia) may also occur.

    In a small number of cases, viruses or bacteria other than H. influenzae type b can cause epiglottitis. In a small number of cases, epiglottitis may be caused by strains ofPneumococcus,Streptococcus,Staphylococcus, orKlebsiella bacteria. Therefore, it is possible that children who have received the HIB vaccine can still develop epiglottitis. Although such cases are also rare, viral epiglottitis can occur after infection with the herpes simplex virus.

    A sore throat, hoarseness, and a high fever can develop rapidly in a child who had no previous symptoms Table 01[Table 2]. The H. influenzae infection usually starts in the nose or throat and progresses down to the epiglottis. The back of the throat usually becomes inflamed, causing pain and hoarseness. It is common to experience a high fever, and to have difficulty swallowing and breathing. Children with epiglottitis may drool and wheeze while inhaling, and often lean forward, stretching the neck to make breathing easier. In many cases, the child will be severely short of breath by the time medical attention is sought.

    The symptoms of epiglottitis in adults are often not as severe as those in children. While children usually experience severe difficulty breathing early in the course of epiglottitis (resulting in a stretched neck and forward-leaning posture), adults more often complain of severe pain in the throat and painful swallowing before developing respiratory symptoms. In addition, the course of the disease may extend over several days in adults, rather than the several hours common in children. As the disease progresses, many adults experience the same breathing difficulties, drooling, and wheezing common in children with the condition.

    Table 1.  Symptoms of Epiglottitis

    Sore throat
    Hoarseness
    Fever
    Difficult or painful swallowing
    Labored breathing or shortness of breath
    Wheezing
    Drooling
    Forward-leaning posture
    Stretched neck

    Children who have not received the HIB vaccine are at the greatest risk for epiglottitis. The HIB vaccine is highly effective, and is recommended for infants older than two months of age. A child who has not been vaccinated will also be at risk for other H. influenzae type b infections such as meningitis and pneumonia.

    Because epiglottitis is a life-threatening medical emergency, it must be diagnosed rapidly; your physician may start treatment before the actual cause of the inflammation has been determined.

    Your doctor will take a brief medical history to narrow down the possible causes of inflammation, and to identify any allergies to antibiotics. Epiglottitis has symptoms similar to those of viral or bacterial croup. To distinguish among the possibilities, your doctor will ask whether or not you have been vaccinated against H. influenzae, whether you have had a barking cough (characteristic of croup), and how quickly symptoms developed (croup usually affects younger children, and develops more slowly than epiglottitis). In addition, your doctor will ask about possible allergies to antibiotics, since antibiotic treatment is one of the first steps taken to treat this condition.

    Epiglottitis can be diagnosed by a physical examination of the epiglottis. Upon physical examination, the epiglottis will be cherry-red in color and swollen. However, touching the back of the throat with a mirror or a tongue suppressor can cause the throat to close suddenly, which can be potentially fatal. Therefore, physical examination is often not done, or is done by a specialist ready to open the airway immediately should it close off.

    X-rays of the neck are often used to diagnose epiglottitis. X-rays of the neck can identify whether or not the epiglottis is swollen. In addition, x-rays can also distinguish between epiglottitis and croup. In croup, the epiglottis is normal in size, and the narrowing occurs lower in the airway, whereas an x-ray of epiglottitis will show narrowing of the airway caused by the inflamed epiglottis. If you are experiencing severe difficulty breathing, treatment will usually be started before any x-rays are taken.

    The doctor will take cultures of secretions from the respiratory tract and a blood sample to help identify the organism causing the infection. These cultures, which will be examined in a laboratory, will help the physician determine the appropriate antibiotics for treatment. Although the doctor will start antibiotic therapy before the laboratory results are available, the cultures will help identify which antibiotics are likely to be most effective against the infectious organism.

    Most cases of epiglottitis can be prevented by immunizing children with the HIB vaccine. The HIB vaccine is very effective, and is recommended for all children between two months and five years of age. It is typically administered in four doses: at two months, four months, six months, and fifteen months of age.

  • Prevention and Screening

    Most cases of epiglottitis can be prevented by immunizing children with the HIB vaccine. The HIB vaccine is very effective, and is recommended for all children between two months and five years of age. It is typically administered in four doses: at two months, four months, six months, and fifteen months of age.

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