Definition Epiglottitis is an inflammation of the epiglottis, which is part of the voice box in the throat.
What is going on in the body? The epiglottis is a cover that folds over the voice box during swallowing. It prevents food from entering the windpipe and lungs. Several things can cause inflammation of the epiglottis. When the epiglottis gets inflamed, it may swell up and block the windpipe. This can cause difficulty breathing and may be a life-threatening condition.
What are the signs and symptoms of the condition? This condition is more common in children than adults. When epiglottitis is caused by an infection, the person may have fever, severe sore throat, and drooling. There is often very noisy breathing when drawing in air. The harder the individual tries to breathe, the louder the breathing. Those with acute epiglottitis tend to lean forward and hold very still. This minimises the obstruction. Epiglottitis is a true medical emergency in children and some adults.
What are the causes and risks of the condition? An upper respiratory infection is probably the most common cause of epiglottitis. The airway of a child is much smaller than an adult, so it takes less swelling to close the airway. Therefore, children are at a greater risk for severe breathing problems. Allergic reactions, exposure to high-pressure steam, or chemicals can cause epiglottitis.
What can be done to prevent the condition? The Haemophilus influenzae type B, or Hib vaccine helps to prevent a common infection leading to epiglottitis in children. Since the Hib vaccine was developed, there has been a decline in epiglottitis cases for those vaccinated. Haemophilus influenzae type B vaccination is part of the Government funded recommended immunisation schedule. Preventing other causes is often not possible.
How is the condition diagnosed? A person with severe sore throat, high fever, and problems breathing may have epiglottitis. Fever and the type of breathing noises are observed. Drooling, leaning forward, and breathing slowly and shallowly are other clues. Adults may need a throat and mouth examination. This is not done in children, because the throat examination can cause worsening of the breathing problems. X-rays of the neck may be needed. For adults, a mirror examination of the top part of the larynx may be done. A flexible telescope placed through the nose can identify the swollen epiglottis.
What are the long-term effects of the condition? An infection that goes away generally has no long-term effects. Steam or a chemical injury can leave scars. There can be chronic hoarseness or airway obstruction.
What are the risks to others? Viral and bacterial infections are contagious. Other causes of epiglottitis do not pose a risk to others.
What are the treatments for the condition? Keeping the person's airway open is the first concern. Some hospitals have epiglottitis teams. These teams have specialists to help the person with epiglottitis. The affected person should try to stay calm. A special breathing tube, known as an endotracheal tube, may need to be put through the mouth or nose into the windpipe. This bypasses the swollen epiglottis. In severe cases, a hole may need to be cut through the neck and into the windpipe. This is called a tracheotomy. Once the airway is secure, tests and treatment begins. Treatment includes antibiotics and steroids. It usually takes 48 to 72 hours to reduce swelling enough to remove the breathing tube. Adults and mildly affected children often do not need a breathing tube.
What are the side effects of the treatments? There may be allergic reactions and other side effects from medications. There may be scarring if a tracheotomy is needed.
What happens after treatment for the condition? Once the swelling has gone away, the child's breathing tube is removed. Oral antibiotics and tapering doses of oral steroids are given at home.
How is the condition monitored? This is a true medical emergency. If there is a suspicion of epiglottitis, someone should call emergency medical services or take the person to the nearest emergency department immediately. However, since the introduction of immunisation, the illness is now rarely seen.
Author: Mark Loury, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
