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Epiglottitis

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Overview

Acute epiglottitis is the inflammation of the epiglottitis, typically caused by the bacteria Haemophilus influenzae type B (Hib). Although it is rare due to Hib vaccination, it is an airway emergency and can be life-threatening.

Epidemiology

  • Due to immunisation to Hib, acute epiglottitis is extremely rare
  • Usually presents at around 2-5 years in children and 40-50 years in adults

Risk Factors

  • No previous Hib vaccine
  • Immunocompromised state

Presentation

Epiglottitis presents as a severe and acute onset of:

  • Sore throat and high fever
  • Muffled voice
  • Drooling
  • Stridor
  • ‘Tripod position’ – the patient finds it easier to breathe sitting leaning forward with the next extended
    • This may manifest in younger children as them wanting to sit upright instead of lying down
  • ‘Toxic appearance’ – lethargy, poor perfusion, cyanosis, inconsolably irritable

Do not examine the airway or do anything that may agitate the child (e.g. separating them from a parent), as this may precipitate the closure of the airway.

Investigations

Overview

Do not examine the airway or do anything that may agitate the child (e.g. separating them from a parent), as this may precipitate the closure of the airway.

The diagnosis of epiglottitis is only made in a controlled operating theatre setting with senior/airway-trained staff. Investigations involve:

  • Laryngoscopy
  • An x-ray may be considered:
    • Posteroanterior view: subglottic narrowing (steeple sign)
    • Lateral view: swelling of the epiglottis (thumb sign)

Differential Diagnoses

Inhaled foreign body

  • Symptoms such as cough present more suddenly
  • Auscultation shows focal wheezing
  • No fever or prodrome of symptoms of a viral illness

Peritonsillar abscess

  • Dysphagia, drooling, occasional stridor, neck stiffness
  • Unilateral cervical lymphadenopathy
  • The uvula may deviate away from the affected side

Tonsillitis

  • Red tonsils with or without tonsillar exudate
  • Stridor, drooling, and ‘tripod’ position are less likely to be present

Croup

  • Barking cough present
  • Drooling, and ‘tripod’ position are less likely to be present unless croup is severe

Management

Overview

  • Immediately alert a senior paediatrician and anaesthetist
  • Secure the airway – endotracheal intubation may be necessary
  • IV antibiotics and corticosteroids may be used

Complications

Prognosis

  • Most patients recover without requiring intubation
  • Earlier identification and treatment result in a good prognosis with a quick and complete recovery

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