Epiglottitis: What You Must Know

Inflammation and swelling of the epiglottis are termed Epiglottitis. Epiglottis is a thin flap of cartilage attached near the base of the tongue that prevents food and liquids from entering the windpipe (trachea) while swallowing. "Acute epiglottitis" indicates the sudden and intense onset of symptoms, including difficulty breathing and swallowing. Epiglottitis can affect people of any age. It affects men more than women.

Routine Hib vaccination in infants has reduced the risk of Epiglottitis in children, and thus it is now more common in adults. The condition requires quick care to prevent deadly consequences.

What causes Epiglottitis?

Epiglottitis is mainly caused by Haemophilus influenza type b (Hib) bacteria. However, Hib bacteria can also cause pneumonia and meningitis. Other possible reasons for Epiglottitis are-

• Bacterial infections from non-Hib sources, like streptococcus pneumonia.

• Fungal infections, especially in people with weak immunity.

• Viral infections, like varicella zoster virus (which causes chickenpox) or herpes simplex virus (which causes cold sores).

• Injury to the throat, either physically or by drinking a scalding liquid.

• Smoking.

• Chemical burns.

• Side effects of another disease or chemotherapy.

It should be remembered that Epiglottitis can be contagious if it is caused by bacterial, fungal, or viral infection. The spread is via droplets from cough or sneezing.

Signs and symptoms of Epiglottitis 

Epiglottitis symptoms usually arise suddenly and worsen quickly. Sometimes, symptoms may take a few days to fully develop in older children and adults. Epiglottitis commonly presents as-

• Severe sore throat.

• Trouble and pain while swallowing (primary symptom in older children and adults).

• Difficulty in breathing (primary sign in children).

• Abnormal or high-pitched breath sounds (primary sign in children).

• Sitting up or erect to breathe (mainly in children).

• Hoarseness or muffling in voice.

• Fever >/=100.4 degrees Fahrenheit/38 degrees Celsius

• Grumpiness and restlessness.

• Drooling (primary symptom in older children and adults).

Healthcare providers often define the common epiglottitis symptoms as "the four Ds":

1. Dysphagia: Difficulty swallowing.

2. Dysphonia: Hoarseness or an abnormal voice.

3. Drooling: involuntarily flow of saliva out of the mouth.

4. Distress: Difficulty while breathing or lack of oxygen.

Risk Factors and Complications Associated with Epiglottitis

There are some risk factors for getting Epiglottitis, like:

• A weakened immune system- by either illness or medicines, prone the individual to get bacterial infections that may cause Epiglottitis.

• Incomplete vaccination. Skipping/non-timely vaccinations can make a child liable to Hib infection and increase their risk of Epiglottitis.

It is essential to learn that Epiglottitis can cause many complications, like

• Breathing failure. The epiglottis functions as a movable "lid" that stops food and drink from entering the windpipe. Swelling of the epiglottis can fully clog the airway, leading to breathing or respiratory failure. This life-threatening condition leads to a very low oxygen level in the blood.

• Spreading infection. Sometimes the bacteria associated with Epiglottitis may spread infections in other parts of the body. 

Identification and diagnosis of Epiglottitis

To diagnose the condition, the doctor performs a physical examination and asks about the symptoms. They may also request certain tests like-

• Laryngoscopy: uses a small camera at the end of a flexible tube to examine the throat.

• Culture tests: utilize a throat swab to test for bacteria or viruses.

• Blood tests: mainly include white blood cells count to see if there are any bacteria or viruses in the blood.

• Imaging tests: mainly include an X-ray or CT (computed tomography) scan that can check the swelling and see the presence of an unwanted object in the airway.

Symptoms of Epiglottitis resemble other conditions, such as croup. Thus, proper diagnosis and treatment are key.

How to manage and treat Epiglottitis?

For managing a case of Epiglottitis, a hospital stay is needed, usually in the intensive care unit (ICU). Treatment includes methods to help the person breathe, like:

• A breathing tube (intubation)

• Moistened (humidified) oxygen

• A surgical airway, called a tracheostomy, is the last resort

Other treatments involve using-

• Antibiotics to treat the infection

• Anti-inflammatory drugs to decrease throat swelling

• Fluids administered through a vein

Epiglottitis can be a life-threatening emergency; however, the outcome is usually good with proper treatment.

Preventive measures -

Epiglottitis can be prevented by receiving the Haemophilus influenzae type b (Hib) vaccine in children under five. However, the Centers for Disease Control and Prevention recommends the vaccine for older children and adults with weak immunity due to Sickle cell disease, HIV/AIDS, Spleen removal, or certain medications. Since the Hib vaccine isn't foolproof, it is crucial to maintain hand hygiene and cough etiquette.

Summary-

Epiglottitis is a severe condition presenting several serious symptoms, including difficulty breathing and swallowing. It is a medical emergency. Prompt and proper care can make epiglottitis treatment successful. Most people recover quickly and receive a discharge from the hospital within one week.