Epiglottis is a small cartilage structure, shaped like a lid, which covers the windpipe. Epiglottitis is a potentially fatal condition which occurs when there is swelling in the epiglottis resulting in blockage of the air flow to the lungs. There are many reasons which cause the epiglottis to swell, such as burns occurring from drinking hot liquids, infections or a direct injury to the throat. Previously the commonest cause of epiglottitis in children was infection occurring from Haemophilus influenzae type b (Hib). This is the same bacterium, which causes meningitis, pneumonia and blood infections. Epiglottitis can affect people of any age.
These days, epiglottitis occurs rarely because of routine Hib vaccination for infants; however, this condition still remains a cause for concern. If you suspect that you or one of your family members has epiglottitis, then seek immediate medical help, as it can prevent potentially life-threatening complications.
Causes of Epiglottitis
An infection or a direct injury is the primary cause of Epiglottitis.
Epiglottitis Caused due to Infection
Infection with Haemophilus influenzae type b (Hib) bacteria is the common cause for swelling and inflammation of the epiglottis and the surrounding tissues. Hib bacterium is the cause of many serious conditions, including meningitis, which is the most common. Hib spreads through droplets which are sneezed or coughed into the air by infected people. You can have the Hib bacteria present in the nose and throat without actually becoming sick; however, you can still contaminate others with the bacteria.
There are other bacteria and viruses, which may also cause inflammation of the epiglottis and they include:
- Streptococcus A, B and C are a group of bacteria, which are also responsible for causing various diseases, such as strep throat and blood infections
- Streptococcus pneumoniae is also a bacterium, which causes pneumonia, meningitis, ear infections and septicemia.
Epiglottitis Caused due to Injury
Direct physical injury to the throat can also cause epiglottitis. This condition can also occur from burns resulting from drinking very hot liquids.
Patient may also experience signs and symptoms which resemble epiglottitis if he/she:
- Swallows a foreign object.
- Swallows a chemical which burns the throat.
- Smokes drugs like crack cocaine.
Risk Factors for Epiglottitis
- Men are more vulnerable for developing Epiglottitis than women.
- People with a weakened immune system, which occurs as a result of medication or any illness, are at an increased risk for bacterial infections, which can cause epiglottitis.
- Children who are not up-to-date with vaccinations are more prone to having epiglottitis.
Signs & Symptoms of Epiglottitis
Symptoms of Epiglottitis in children comprise of:
- Patient has drooling.
- Patient has fever.
- Patient experiences severe throat soreness.
- The voice of pateitn suffering from Epiglottitis becomes abnormal and has a high-pitched sound when inhaling (stridor).
- Patient experiences anxiety and is restless.
- Epiglottitis patient has difficulty in swallowing and experiences pain upon swallowing.
- Patient suffering from Epiglottitis finds comfort when leaning forward or sitting up.
- Epiglottitis Symptoms in Adults are similar and they tend to develop gradually taking days rather than hours and can include: Drooling, severe sore throat, fever, hoarse or muffled voice, stridor, difficulty in breathing and swallowing.
Epiglottitis should not be taken lightly, as it is a medical emergency. If any person has difficulty breathing and swallowing, then patient should IMMEDIATELY be taken to the nearest hospital emergency department. Patient should be kept quiet and seated in an upright position, as it will make breathing easier. NEVER try to examine the patient's throat on your own, as this can worsen the situation.
Investigations for Epiglottitis
If epiglottitis is suspected then the immediate priority is to ensure that the patient's airway is open and patient is getting enough oxygen. Initial testing comprises of a pulse oximeter which is a device that assesses the oxygen levels in the blood. This device is clipped onto a finger and it measures the amount of saturation of the oxygen in the blood. If the oxygen saturation levels are very low, then the patient may need help with his/her breathing.
Tests which are done after stabilizing the breathing are:
- Throat examination is done using a tube, which is flexible and fiber-optic-lighted. The doctor inspects the child's throat with it to see what is causing the patient's symptoms. Local anesthetic can be given to help with the discomfort.
- X-ray of the neck or chest is taken due to the danger of sudden breathing problems. The airway should be protected before taking the x-rays and children usually get theirs taken near their bedside. In case of epiglottitis, a thumbprint type of image can be seen in the neck on an x-ray, which indicates an enlarged epiglottis.
- Blood tests and throat culture are also done. The culture is taken by swiping the epiglottis with a cotton swab and the sample is tested for Hib. Blood cultures are taken to confirm or exclude the bacteremia, which is an acute bloodstream infection that can accompany epiglottitis.
Treatment for Epiglottitis
The first line of treatment for epiglottitis comprises of making sure that the patient can breathe. Then the cause of epiglottitis is identified and treated. As stated above, the first priority in treatment of epiglottitis is ensuring that the patient is receiving sufficient air. This comprises of:
- Wearing a mask which delivers oxygen to the lungs.
- Intubation is done where a breathing tube is placed into the windpipe via the nose or the mouth. This tube should be kept till the swelling in the patient's throat subsides. This may sometimes take several days.
- Needle tracheostomy is done where a needle is inserted into the trachea. If conservative measures fail or in extreme cases the doctor can create an emergency airway where a needle is inserted directly into the area of cartilage of the patient's trachea. This procedure permits air into the lungs while bypassing the larynx.
Treatment for Epiglottitis Caused due to Infection
If epiglottitis occurs as a result of infection, then intravenous antibiotics are started after the patient starts getting sufficient air.
- Broad-spectrum antibiotics are started for immediate treatment instead of waiting for the blood and tissue culture results.
- Targeted antibiotics can be started later on after the culture results are back and the cause of epiglottitis is identified.
Prevention of Epiglottitis
- Hib vaccine for immunization should be given on the scheduled times, as this is a very effective way to prevent epiglottitis, which is caused by Hib. The vaccine is usually given in three or four doses. The Hib vaccine is usually not given to children who are over the age of 5 or to adults, as they are at a lesser risk for developing Hib infection. However, Hib vaccine is recommended for older children and adults who have weakened immune systems due to sickle cell disease, spleen removal, HIV/AIDS, chemotherapy and who are given medications which prevent rejection of bone marrow transplants or organ.
Side Effects of Vaccine are:
- Possible mild side effects include warmth, redness, swelling at the site of the injection and patient can also have fever.
- Allergic reaction, such as difficulty breathing, hives, wheezing, weakness, tachycardia, dizziness can occur within a few minutes or a few hours after the injection. Immediate medical help should be sought in such cases.
Other than taking Hib vaccine, other precautions should be taken to prevent infections, such as:
- Avoiding sharing personal items.
- Frequently washing hands.
- Using an alcohol-based hand sanitizer in case soap and water are not available.