Epiglottitis, also known as supraglottitis, is an acute inflammation of the epiglottis and surrounding area. It is a life-threatening emergency that rapidly causes edema and induration of the epiglottis and may result in airway obstruction. If left untreated, epiglottitis can result in complete airway obstruction. Epiglottitis can occur from infancy to adulthood in any season, but it is seen more often in children. The illness is fatal in 8% to 12% of patients, typically children between ages 2 and 8, and affects males more frequently than females.
Epiglottitis usually results from infection with the bacteria Haemophilus influenzae type b (Hib); occasionally, pneumococci or group A streptococci is the culprit. Since the introduction of the Hib conjugate vaccine in 1990, the incidence of epiglottitis has decreased significantly.
Airway obstruction and death may occur within 2 hours of onset.
The patient or his or her parents may report a previous upper respiratory tract infection. Additional complaints include sore throat, dysphagia, and the sudden onset of a high fever.
On inspection, the patient may be febrile, drooling, pale or cyanotic, restless, apprehensive, and irritable. Nasal flaring and chest and neck muscle retraction may also be observed. Inspiratory stridor will be present. The patient may sit in a tripod position: upright, leaning forward with the chin thrust out, mouth open, and tongue protruding. This position helps relieve severe respiratory distress. The patient’s voice usually sounds thick and muffled.
Manipulation may trigger sudden airway obstruction, so do not attempt throat inspection until immediately prior to intubation. The patient’s throat appears red and inflamed.
Epiglottitis can progress to complete airway obstruction within minutes. To prepare for this medical emergency, keep the following in mind:
Watch for increasing restlessness, tachycardia, fever, dyspnea, and intercostal and substernal retractions. These are warning signs of total airway obstruction and the need for an emergency tracheotomy.
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