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Epiglottitis
Introduction
Epiglottitis is a life-threatening condition that occurs when the epiglottitis— a small cartilage "lid" that covers the windpipe — swells, blocking the flow of air into the lungs.
A number of factors can cause the epiglottis to swell, including burns from hot liquids, a direct injury to the throat, and various viral and bacterial infections. The most common cause of epiglottitis is infection with Haemophilus influenzae type b (Hib), the same bacterium that causes pneumonia and meningitis.
Routine Hib vaccination for infants has made epiglottitis an uncommon condition, but it remains a valid concern. If you suspect that you or someone in your family has epiglottitis, seek emergency help immediately. Prompt treatment can prevent life-threatening complications.
Signs and symptoms
Epiglottitis caused by Hib infection usually begins with a fever and severe sore throat. Other signs and symptoms may develop within a matter of hours, including:
- Difficult and painful swallowing.
- Drooling due to severe pain when swallowing.
- A muffled voice.
- Harsh, raspy breathing.
- Difficulty breathing.
- Anxiety.
- Blue skin or lips.
Your voice box (larynx) is a framework of cartilage, muscle and mucous membrane that forms the entrance to your windpipe (trachea), the tube that connects your mouth and throat to your lungs. The epiglottitis is a small, movable "lid" just above the larynx that prevents food and drink from entering your windpipe.
It does this by dropping down when you swallow, effectively sealing off the larynx. That's why you can't swallow and breathe at the same time. When you're not eating or drinking, the epiglottis is slightly lifted so that air can flow freely into your lungs. But if the epiglottis becomes swollen — either from infection or injury — the airway narrows and may become completely blocked.
Infection
The most common cause of swelling and inflammation of the epiglottitis and surrounding tissues is infection with Haemophilus influenzae type b (Hib) bacteria. Hib isn't the germ that causes the flu, but it's responsible for other serious conditions — including respiratory tract infections and meningitis.
Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib in your nose and throat without becoming sick — though you still have the potential to spread the bacteria to others.
Other bacteria and viruses also can cause inflammation of the epiglottitis, including:
- Streptococcus pneumoniae (pneumococcus), the most common cause of meningitis.
- Streptococcus A, B and C, a group of bacteria that cause diseases ranging from strep throat to blood infections.
- Candida albicans, the fungus responsible for vaginal yeast infections, diaper rash and oral thrush.
- Varicella zoster, the virus responsible for chickenpox and shingles.
Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can scald burns to your face or burns from drinking very hot liquids.
You also may develop signs and symptoms similar to those of epiglottitis if you:
- Swallow a chemical that burns your throat.
- Swallow a foreign object.
- Smoke drugs, such as crack cocaine and heroin.
The first priority in treating epiglottitis is ensuring that you're receiving enough air. You may wear a mask that delivers oxygen to your lungs. Or you may have a breathing tube placed into your windpipe through your nose or mouth. The tube must remain in place until the swelling in your throat has decreased — sometimes up to two or three days.
In extreme cases or if more conservative measures fail, the doctor may create an emergency airway by inserting a needle directly into an area of cartilage in your trachea. This procedure allows air into your lungs while bypassing the larynx. The needle is removed as soon as the airway is open.
If your epiglottitis is related to an infection, you'll receive intravenous antibiotics once you're breathing freely. Until your doctor knows the results of your blood and tissue cultures, you're likely to be treated with a broad-spectrum drug. You may receive a different antibiotic later, depending on what's causing your epiglottitis.
Prevention
Immunization with the Hib vaccine is the most effective way to prevent epiglottitis in children younger than age 5. In the United States, children usually receive the vaccine in four doses: at ages 2 months, 4 months, 6 months and 12 to 15 months.
The Hib vaccine is generally not given to children older than age 5 or to adults because they're less likely to develop Hib infection. But the Centers for Disease Control and Prevention recommends the vaccine for older children and adults whose immune systems have been weakened by:
- Sickle cell disease.
- HIV/AIDS.
- Spleen removal.
- Chemotherapy.
- Medications to prevent rejection of organ or bone marrow transplants.
Of course, the Hib vaccine doesn't offer guarantees. Immunized children have been known to develop epiglottitis — and many other germs can cause epiglottitis, too. That's where common-sense precautions come in. Don't share personal items. Wash your hands frequently. If soap and water aren't available, use an alcohol-based hand sanitizer.
Information obtained from National Institute of Health