Supraglottitis

Alternative names
Epiglottitis

Definition
Epiglottitis is a disorder caused by inflammation of the cartilage that covers the trachea (windpipe). See also croup syndrome.

Causes, incidence, and risk factors

Epiglottitis is most common in children between 2 and 6 years old and is usually caused by the bacterium Haemophilus influenzae, although it may be caused by other bacteria or viruses. Although rare, epiglotitis can occur in normal adults. Because it is rare in adults, it may be easily overlooked as a diagnosis. The condition can progress rapidly. In the US, the incidence of this disease has decreased steadily since Haemophilus influenzae type B (Hib) vaccine became a routine childhood immunization in the late 1980s.

Epiglottitis is a life-threatening disease that begins with a high fever and very sore throat. The epiglottis (the flap of cartilage at the back of the tongue that closes off the windpipe when swallowing) swells and can obstruct breathing. Respiratory distress increases rapidly as the epiglottis swells.

Immunosuppression (from medications or diseases that reduce the action of the immune system) can predispose adults to epiglottitis.

Swallowing problems may be associated with drooling. Breathing difficulty may cause the patient to sit up, leaning slightly forward and looking very anxious. Spasm may cause the airway to close abruptly. In this case, death follows within minutes. Do not make any attempts to look into the patient’s mouth if epiglottitis is suspected.

Immediate emergency medical help is imperative! EPIGLOTITIS IS A MEDICAL EMERGENCY.

Symptoms

     
  • Drooling  
  • Sore throat  
  • Difficulty swallowing  
  • Difficulty breathing (patient may need to sit upright leaning slightly forward to breathe adequately)  
  • Stridor (noisy breathing, “crowing” sound when inhaling)  
  • Hoarseness  
  • Chills, shaking  
  • Fever  
  • Cyanosis (blue skin coloring)

Signs and tests

Do not attempt to examine the throat (larynx) at home, because use of the tongue blade may cause the condition to worsen.

The health care provider will examine the larynx (laryngoscopy) and may find an enlarged, reddened epiglottis. Anesthesia may be required for laryngoscopy in a patient with epiglottitis, in the event insertion of a breathing tube (intubation) becomes necessary to maintain the airway.

     
  • Stridor may be present.  
  • Blood culture or throat culture may show H. influenzae or other bacteria.  
  • A CBC may show an elevated WBC count.  
  • Neck x-rays may show enlargement of the epiglottis.

Treatment

Hospitalization is required because this is an emergency situation. The patient is usually admitted to the intensive care unit.

Treatment usually involves the administration of humidified oxygen, which is oxygen that has been moistened to help the patient breathe. The patient will probably be intubated, meaning a tube is passed through the nose or mouth into the trachea to help the patient breathe.

Intravenous fluids are given to increase hydration. Antibiotics are used to treat the infection. Corticosteroids may be used to decrease the swelling of the throat.

Expectations (prognosis)
Epiglottitis can be a life-threatening emergency. However, with proper treatment, the outcome is usually good.

Complications

The airway may become totally obstructed, which could result in death.

Calling your health care provider
Go immediately to the emergency room or call the local emergency number (such as 911) if your child has symptoms suggestive of epiglottitis, including rapid onset of breathing difficulties, excessive drooling, and irritability.

Prevention
The bacterial infection that causes epiglottitis is contagious, so family members should be screened and treated if appropriate. Have your children immunized with the Hib vaccine.

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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