Epiglottitis

The epiglottis functions as a barrier between the trachea and the laryngopharynx. It prevents food from entering into the trachea when swallowing, yet remains patent when talking.

Pathophysiology

The epiglottis can become inflamed due to haemophilia influenza type B (Hib) infection. It was previously thought to be a childhood disease, but due to immunisation programmes including the Hib vaccine, it is now more common in adult populations.

Dipht

😷 Presentation

Due to the location of the epiglottis, it is important that epiglottitis is recognised and treated promptly, otherwise it can develop into an airway obstruction.

It’s presentation is similar to croup but with a faster onset:

Rapid onset
Sore throat
Stridor
Drooling
Tripod position - patient leans forward and extends neck while in a seated position as this is an easier position for them to breathe
Fever and general malaise
Muffled voice

🔍 Investigations

If there is an acutely unwell patient with suspected epiglottitis then we should not perform investigations.

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Clinical diagnosis: 🏆 This is made by direct visualisation of a trained staff member to look for a swollen and inflamed epiglottis.

Throat swabs and bloods should also be taken.

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Imaging: Lateral neck X-ray will show a characteristic thumbprint sign. This is due to an oedematous and swollen epiglottis. An X-ray is also useful to exclude a foreign body.

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The thumbprint sign for epiglottitis differs from the steeple sign seen in croup.

🧰 Management

Senior staff should be immediately involved (anaesthetist, ENT, paediatrician). However, it is important to not distress the patient as this could close the airway promptly. If a child is suspected with epiglottitis, it is best to leave them alone and not examine them, but rather alert senior staff immediately.

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Secure the airway!

This is not done through intubation, but it can be needed at any time if the airway closes, so someone needs to be on hand and ready to perform endotracheal intubation once it closes. Transfer to ICU is needed. A tracheostomy may be needed if the airway is completely closed.

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Medical management: Once the airway is secure, patients can be given IV antibiotics and steroids, and oxygen.

Antibiotics - IV ceftriaxone or chloramphenicol if allergic to cephalosporins.
Steroids - IV dexamethasone
Nebulised adrenaline may also be given to prevent upper airway oedema.

Contacts of the patient who are unvaccinated need to be given vaccinations prophylactically.