Epiglottitis is inflammation and swelling of the epiglottis, the thin cartilage structure at the root of the tongue that closes off the windpipe (trachea) when foods or liquids are being swallowed.
Epiglottitis (or, more correctly, supraglottitis) should be suspected when a patient presents with a rapidly developing sore throat or when odynophagia (pain on swallowing) is out of proportion to apparently minimal oropharyngeal findings on examination. It is more common in diabetic patients and may be viral or bacterial in origin. Rarely in the era of H influenzae type b vaccine is this bacterium isolated in adults. Unlike in children, indirect laryngoscopy is generally safe and may demonstrate a swollen, erythematous epiglottis. Lateral plain radiographs may demonstrate an enlarged epiglottis (the epiglottis “thumb sign”).
Signs and symptoms
The symptoms of epiglottitis are the same regardless of the cause. However, they may differ between children and adults. Children can develop epiglottitis within a matter of hours. In adults, it often develops more slowly, over the course of days.
The symptoms of epiglottitis that are common in children include:
- a high fever
- lessened symptoms when leaning forward or sitting upright
- sore throat
- a hoarse voice
- difficulty swallowing
- painful swallowing
- breathing through their mouth
Symptoms common in adults include:
- difficulty breathing
- difficulty swallowing
- a raspy or muffled voice
- harsh, noisy breathing
- a severe sore throat
- an inability to catch their breath
If epiglottitis is untreated, it can block your airway completely. This can lead to bluish discoloration of your skin due to lack of oxygen. This is a critical condition and requires immediate medical attention. If you suspect epiglottitis, seek medical attention immediately.
Tests done to diagnose epiglottitis include the following.
- A laryngoscopy, using a small camera at the end of a flexible tube, is done to examine the throat.
- A swab of the throat is taken to test for bacteria or viruses.
- Blood tests check the white blood cell count (a high count means the immune system is fighting an infection), and to find any bacteria or viruses in the blood.
- An X-ray or CT (computed tomography) scan may be used to determine the level of swelling, and to see if there is a foreign object in the airway.
Since epiglottitis and croup share a number of common symptoms, it is important that testing pinpoint the illness correctly so that the proper treatment may be given. Unlike croup, which appears mainly during the winter months, epiglottitis is no more common during one part of the year than another.
Initial treatment is hospitalization for intravenous antibiotics— eg, ceftizoxime, 1–2 g intravenously every 8–12 hours; or cefuroxime, 750–1500 mg intravenously every 8 hours; and dexamethasone, usually 4–10 mg as initial bolus, then 4 mg intravenously every 6 hours—and observation of the airway.
Corticosteroids may be tapered as symptoms and signs resolve. Similarly, substitution of oral antibiotics may be appropriate to complete a 10-day course. Less than 10% of adults require intubation.
Indications for intubation are dyspnea, rapid pace of sore throat (where progression to airway compromise may occur before the effects of corticosteroids and antibiotics), and endolaryngeal abscess noted on CT imaging.
If the patient is not intubated, prudence suggests monitoring oxygen saturation with continuous pulse oximetry and initial admission to a monitored unit.