Epiglottitis
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Epiglottitis is a life threatening condition characterised by acute inflammation of the epiglottis and supraglottic structures, leading to airway obstruction.
Aetiology
- Bacterial infections (most common): Haemophilus influenzae type B (HiB), Streptococcus pneumoniae, Staphylococcus aureus.
- Viral infections: less common but includes herpes simplex virus (HSV) and varicella-zoster virus.
- Trauma: direct injury from burns, chemical exposure, or foreign bodies.
- Non-infectious causes: thermal or caustic injury.
Pathophysiology
- Bacterial invasion of the epiglottis leads to rapid inflammation and swelling.
- Swelling of the supraglottic structures narrows the airway, leading to stridor and respiratory distress.
- If untreated, airway obstruction can progress rapidly to respiratory failure.
Risk Factors
- Incomplete or absent HiB vaccination.
- Immunocompromised states (e.g., HIV, chemotherapy).
- Recent upper respiratory tract infection.
- Smoking and exposure to irritants.
Signs and Symptoms
- Rapid onset fever: high-grade temperature.
- Severe sore throat: disproportionate to oropharyngeal findings.
- Dysphagia and drooling: due to difficulty swallowing.
- Stridor and respiratory distress: late signs indicating airway compromise.
- Tripod position: patient leaning forward to optimise breathing.
- Muffled "hot potato" voice: indicative of airway swelling.
Investigations
- Clinical diagnosis: avoid unnecessary examination that could precipitate airway obstruction.
- Lateral neck X-ray: "thumbprint sign" indicative of epiglottic swelling.
- Blood cultures: if sepsis is suspected.
- Direct fibre optic laryngoscopy: in a controlled setting to confirm diagnosis.
Management
1. Emergency Airway Management:
- Immediate senior anaesthetic and ENT involvement.
- Do not attempt throat examination: risk of sudden airway obstruction.
- Secure airway: early intubation or tracheostomy in severe cases.
2. Medical Treatment:
- IV antibiotics: ceftriaxone or cefotaxime (broad-spectrum cover).
- Corticosteroids: may reduce airway oedema.
- IV fluids: maintain hydration and support circulation.
3. Monitoring and Supportive Care:
- Continuous cardiorespiratory monitoring in high dependency or intensive care setting.
- Supplemental oxygen if required.
4. Referral:
- ENT specialist: for airway assessment and possible intervention.
- Intensive care unit (ICU): if respiratory compromise is imminent.
- Infectious diseases: if atypical or recurrent infections are suspected.