Introduction:
The epiglottis is a cartilaginous flap positioned in the throat, situated behind the tongue, and in front of the larynx (voice box). Typically, it remains in an upright position, allowing air to flow freely into the larynx and lungs. However, during the act of swallowing, the epiglottis folds backward, effectively covering the entrance to the larynx. This protective mechanism prevents food and liquids from entering the windpipe and lungs. Once the swallowing process is complete, the epiglottis returns to its original upright position.
What Is Epiglottitis?
Epiglottitis is a serious and potentially life-threatening condition marked by the presence of inflammation and significant swelling of the cartilaginous flap, the epiglottis. The swollen epiglottis can block the airway, leading to difficulty when breathing and potentially causing respiratory distress. Due to the relatively smaller diameter of the epiglottic opening in children, there has been a higher incidence of epiglottitis in children compared to adults.
What Causes Epiglottitis?
Epiglottitis can be caused by an infection or injury.
A. Infections: Infections caused by Haemophilus influenza type B (Hib) bacteria used to be a common cause of epiglottitis, but the incidence has significantly decreased due to Hib vaccines. Other bacteria and viruses, such as Streptococcus pneumonia, Streptococcus A, B, and C, and Staphylococcus aureus, can also cause swelling of the epiglottis in adults.
B. Injuries: Injuries, although rare, such as a direct impact on the throat or exposure to hot liquids or smoke, can potentially cause epiglottitis.
C. Others: Certain factors or behaviors, like swallowing burning chemicals, and objects, can result in symptoms resembling epiglottitis.
D. Habits: Smoking electronic cigarettes or drugs may also be a potential cause of epiglottitis.
What Are the Symptoms of Epiglottitis?
Epiglottitis presents similar symptoms regardless of its cause, but there can be variations in symptom progression between children and adults. In children, the onset of epiglottitis can occur rapidly, often within a few hours. Conversely, in adults, the development of symptoms tends to be slower, taking place over several days. Epiglottitis presents symptoms such as:
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Severe Sore Throat - The throat is typically very painful and may make swallowing difficult.
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High Fever - Epiglottitis is often accompanied by a high body temperature.
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Difficulty Swallowing (Dysphagia) - The swelling of the epiglottis can make it challenging to swallow both solids and liquids.
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Muffled or Hoarse Voice (Dysphonia) - The inflammation can affect the voice, resulting in a muffled or hoarse sound.
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Drooling - Difficulty swallowing may lead to increased saliva production and drooling.
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Distressed Breathing - As the epiglottis swells, it can partially block the airway, causing breathing problems, such as shortness of breath, rapid breathing, or noisy breathing.
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Stridor - This is a sound characterized by a high pitch produced during breathing due to the narrowed airway.
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Restlessness and Agitation - Children with epiglottitis may appear anxious, restless, or irritable.
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Cyanosis - Cyanosis is a condition usually observed in severe cases; the lack of sufficient oxygen may cause a bluish discoloration of the skin, particularly the lips and nails.
How Is Epiglottitis Diagnosed?
Initially, the medical team focuses on ensuring the patency of the airway and maintaining adequate oxygenation. They closely monitor the patient's breathing and blood oxygen levels. In cases where oxygen levels become insufficient, respiratory support or breathing aids may be necessary to provide supplemental oxygen. After ensuring a patent airway, the diagnostic process for epiglottitis may include the following:
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Physical Examination - The doctor will examine the throat, neck, and airway to look for signs of inflammation and airway obstruction. A lighted instrument with a camera called a laryngoscope may be used to visualize the epiglottis and surrounding structures. Laryngoscopy helps in confirming the diagnosis of epiglottitis and assessing the severity of the condition, guiding appropriate treatment decisions.
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X- Rays - X-rays, such as lateral neck X-rays or soft tissue neck X-rays, or a chest X-ray, may be conducted to evaluate the size and shape of the epiglottis and to assess for any signs of swelling or obstruction. An X-ray image may reveal a distinct finding known as a "thumbprint sign" in the neck, indicating the presence of an enlarged epiglottis.
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Blood Tests - Blood samples may be taken to check for signs of infection and to evaluate white blood cell count and inflammatory markers such as elevated erythrocyte sedimentation rate (ESR). A blood culture is also done to check for the presence of bacteria in the blood (bacteremia), which is frequently associated with epiglottitis.
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Swab Tests: If a bacterial infection is suspected, a sample may be taken from the throat or respiratory tract to identify the specific bacteria or virus causing the infection. This can help decide the appropriate medication for treatment.
How Is Epiglottitis Treated?
The initial step in treating epiglottitis is to ensure adequate breathing, followed by addressing the underlying infection. The treatment process involves two main aspects:
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Assisting With Breathing - The first priority is to establish and maintain a clear airway. This may involve:
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Oxygen Mask - Administering oxygen through an oxygen mask to support proper lung function.
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Intubation - In severe cases, when the airway is significantly compromised, inserting a breathing tube into the windpipe (intubation) to provide a stable airway. This may be necessary until the throat swelling subsides, which can take several days.
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Needle Cricothyroidotomy - In rare instances, an emergency procedure that involves inserting a needle into the windpipe to establish an alternative airway quickly may be performed.
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Treat the Underlying Infection - As the causative agent of epiglottitis becomes identified through culture tests, the antibiotic treatment can be adjusted to a more targeted medication if necessary.
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Intravenous antibiotics are the primary treatment for epiglottitis.
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Initially, a broad-spectrum antibiotic (for example, Cefuroxime) may be prescribed to ensure prompt management of the infection without waiting for specific blood or tissue culture results.
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Who Is at Risk of Developing Epiglottitis?
Epiglottitis can occur in individuals of any age, but certain factors may increase the risk:
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Children under 12 months and between the age of two to six years.
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Aged adults.
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Unvaccinated or incompletely vaccinated against Haemophilus influenza type B (Hib).
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Being a male.
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Respiratory infections such as chronic pulmonary obstructive disease (COPD).
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Weakened immune systems due to underlying medical conditions such as diabetes or human immunodeficiency virus (HIV).
What Are the Complications of Epiglottitis?
Epiglottitis, if left untreated or inadequately managed, can lead to several complications. The infection that causes epiglottitis can spread to nearby structures, such as the lungs (pneumonia), the bloodstream (bacteremia), or the covering of the heart (endocarditis). These systemic infections can lead to severe illness and complications. In some cases, a collection of pus (abscess) may develop in the throat or surrounding tissues. This can further obstruct the airway and increase the risk of complications.
Conclusion:
By being aware of the symptoms and seeking immediate medical attention, appropriate interventions are taken to manage epiglottitis effectively. Individuals may still encounter long-term complications such as voice alterations, difficulty swallowing, and emotional distress resulting from the traumatic episode. Timely intervention remains a critical factor in ensuring the effective management of epiglottitis and maximizing the chances of a favorable outcome.
