Epiglottitis

Definition
Epiglottitis is an inflammation of the epiglottis, a flap of tissue that covers the larynx (voice box) and trachea (windpipe) to protect your airway when you swallow. The tissue surrounding the epiglottis also becomes inflamed and swollen. If epiglottitis is not treated immediately, the airway can become blocked. The resulting respiratory distress may be fatal within a matter of hours. Epiglottitis is always considered a medical emergency.

Causes/associated factors
Epiglottitis is an uncommon disease. It's often caused by the bacterium Haemophilus influenzae type B (Hib), but other types of bacteria, viruses or fungi may be responsible. It may also develop after trauma or a heat-related injury.
Epiglottitis used to be most common in children. With the introduction of the Hib vaccine, however, it's now more common in adults. When children do develop epiglottitis, it's usually between ages 2 and 7. Those who have weak immune systems are at higher risk, even if they've been immunized. Among adults, men and smokers are at greater risk.


Transmission
Epiglottitis itself isn't contagious, but the organism causing the infection is. Hib bacteria and other organisms that can cause epiglottitis are thought to spread primarily through infected respiratory droplets. Exposure to Hib bacteria or other organisms causing epiglottits may or may not cause infection, however.

Signs/symptoms
Again, epiglottitis is a life-threatening emergency that requires immediate medical attention. The condition can develop within just a few hours. Early symptoms may include high fever, severe sore throat and difficulty swallowing. As breathing difficulty rapidly progresses, other symptoms may be:
sitting, leaning forward with chin hyperextended for easier breathing
noisy breathing (sometimes a crowing sound when breathing in)
muffled voice or difficulty speaking, crying or making sounds
drooling
blue tinge to the lips or nail beds
irritability, restlessness
fatigue, lethargy or unresponsiveness

Diagnosis
A throat exam is required to diagnose epiglottitis, but great care must be taken during this exam. With this condition, the epiglottis is red and enlarged. Use of standard exam equipment, such as a tongue depressor or an instrument called a laryngoscope, may lead to sudden obstruction of the airway when epiglottitis is present, especially in children. Because of this risk, the throat exam is ideally done by an ear, nose and throat specialist with an anesthesiologist present, preferably in an operating room under general anesthesia. If the airway becomes blocked, the doctor can reopen it by intubation (placing a tube through the mouth or nose into the trachea) or, in rare cases, by tracheostomy (creating a new airway by making an incision into the trachea, or windpipe, at the front of the neck).
Analysis of blood samples and secretions from the upper respiratory tract (nose and mouth) may also help confirm the presence of bacteria, including Hib, once the person is stabilized. Sometimes, X-rays are done as well.


Treatment
Prompt identification of epiglottitis with proper emergency room treatment leads to a better outcome for this life-threatening condition. If you're helping someone you suspect has epiglottitis, try to keep the person calm and upright while seeking emergency medical attention. Agitation will only worsen the situation. Do not offer anything to eat or drink.
Most people with epiglottitis are admitted to the intensive care unit. Besides intubation or a tracheostomy, the person may also need oxygen or mechanical ventilation (a medical device that helps the person breathe). The doctor will usually give antibiotics to control the underlying infection, steroids to decrease airway swelling, and fever-reducing medications. With immediate treatment, most people recover completely.


Complications
Complete blockage of the airway may cause respiratory failure, which can be fatal. Pneumonia (a lung infection) may accompany epiglottitis. The infection may also spread to the joints, the lining of the brain, the sac around the heart, or throughout the bloodstream and body.

Pregnancy-specific information
Pregnancy does not increase the risk of developing epiglottitis. Should you develop this emergency condition while pregnant, you'll have the same basic stabilization needs as any other patient. Discuss any concerns you may have with your doctor.

Senior-specific information
Epiglottitis is not considered a common problem for any age group, including older adults.

Prevention
Thanks to widespread Hib immunizations in young children, the number of epiglottitis cases has been dramatically reduced. It's recommended that children receive the first Hib vaccine at age 2 months with the series continuing through 12 to 18 months. Contact your doctor or local health department for more information about the vaccine.
For Hib epiglottitis, preventive antibiotics are sometimes given to close contacts. If you've been exposed, consult a doctor for advice about preventive treatment.