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Epiglottitis

Definition

Epiglottitis is a rare swelling of the epiglottis. The epiglottis is the small flap in the back of the throat. With swallowing, it folds over the windpipe. It helps keep foods and fluids from going into the lungs. Swelling can quickly seal off the airway. This can cause life-threatening breathing problems. It needs to be treated right away.
The Throat
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Causes

Epiglottitis can be caused by:
  • Bacteria, viruses, and fungi
  • Burns from hot liquids
  • Injury to the throat area
  • Crack cocaine use

Risk Factors

Epiglottitis spreads easily. It is passed like the common cold, through droplets from sneezing and coughing. It is more common in infants under 12 months and adults over 85 years old. However, anyone can develop epiglottitis.
Other things that raise the risk are:
  • Not having the Haemophilus influenzae type b (Hib) vaccine
  • A weak immune system
  • Chronic diseases, such as high blood pressure and COPD
  • Living in close quarters

Symptoms

Symptoms appear suddenly and worsen quickly. They may be:
  • Fever over 103 °F (degrees Fahrenheit) / (38.9 °C)
  • Severe sore throat
  • Problems swallowing and drooling
  • Problems breathing
  • Cough
  • Being irritable
  • Voice changes
  • Squeaky or raspy sounds while inhaling

Diagnosis

At the hospital, breathing will be checked. The doctor will ask about your symptoms and health history. A mirror may be used to look down the throat.
To look for infection or other problems, tests may be done, such as:
  • Blood culture and count
  • Throat culture
Images may be taken to look for problems in the nose, neck, and throat area. This can be done with:

Treatment

The first goal of treatment is to make sure the airway is open. If the person cannot breathe, emergency care is given, such as:
  • Endotracheal intubation—a breathing tube is put through the nose or mouth to the airway
  • Tracheotomy—a breathing tube is inserted directly into the airway, if the airway is swollen shut
The cause of epiglottitis also needs to be treated. Options are:
  • IV antibiotics—to treat infection
  • IV corticosteroids—to reduce swelling
Supportive treatments may also be given, such as oxygen and IV fluids.

Prevention

Vaccination with the Hib vaccine can prevent epiglottitis. Antibiotics may be prescribed to those exposed to an infected person.

RESOURCES

American College of Emergency Physicians
https://www.acep.org
Centers for Disease Control and Prevention
https://www.cdc.gov

CANADIAN RESOURCES

Health Canada
https://www.canada.ca
Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References

Acute epiglottitis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-epiglottitis. Accessed March 29, 2021.
Baiu I, Melendez E. Epiglottitis. JAMA. 2019;321(19):1946.
Epiglottitis. Merck Manual website. Available at:
Haemophilus influenzae disease (including Hib). Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/hi-disease/index.html. Accessed March 29, 2021.

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