By Dr Ananya Mandal, MD
Epiglottitis results in inflammation and swelling of the epiglottis. This may cause obstructing in the airway.
As the disease progresses rapidly – sometimes over hours – it may lead to choking and death. Thus, epiglottitis especially in children and elderly is an emergency.
Who treats epiglottitis?
The team of health care providers in a case of epiglottitis include an anaesthesiologist and an ear, nose, and throat (ENT) specialist or a general surgeon.
An infectious disease specialist or a microbiologist may be brought in especially if there is no response to initial antibiotics.
Getting medical help for epiglottitis
Once the condition is suspected the ambulance should be called and the patient shifted to the emergency department where his or her airway is secured to reduce the risk of obstruction in breathing.
The patient is allowed to take a position he or she feels most comfortable in. This is usually the tripod position where the patient sits on his or her hands with head bent forward slightly and tongue protruding out.
If there is severe obstruction of airway at home, paramedics might try to insert an endotracheal tube. One end lies within the airways or trachea and the other is connected to an oxygen cylinder.
If endotracheal intubation is not possible, the paramedics might insert a needle into the trachea or cut open the front part of the trachea to insert a tracheostomy tube to help the patient breathe.
This is called percutaneous transtracheal jet ventilation or cricothyrotomy and emergency tracheostomy. This should not be attempted by untrained persons.
Treatment of epiglottitis
Treatment of epiglottitis includes endotracheal intubation, antibiotic therapy and so forth. (1-6)
Patients are shifted to the intensive care unit (ICU) under closed monitoring and if not attempted previously they should undergo endotracheal intubation.
If there is severe obstruction and respiration is depressed the patient may need the support of an artificial ventilator in order to breathe.
Once the tube is in place humidified oxygen is administered.
Antibiotic therapy is begun as soon as diagnosis is made. Specific antibiotics that are effective against the causative organism may be started after the results of epiglottic cultures are obtained and the infective organism identified.
Usually therapy is begun with antibiotics like ampicillin/sulbactam, amoxicillin/clavulanic acid or cephalosporin group of drugs like ceftriaxone (given intravenously), cefuroxime (can be given both intravenously and orally) and cefotaxime (given intravenously).
Chloramphenicol is another alternative antibiotic that can be given in patients who are allergic to penicillin. Most people will need to take a seven- to ten-day course of antibiotics.
Antibiotics may be started intravenously and with adequate initial response to the infection they may be switched over to oral antibiotic pills as appropriate.
Trying to reduce the swelling of epiglottitis
Earlier guidelines have recommended adrenaline and corticosteroids in reduction of the swelling of the epiglottis. These have not been found to be of much use.
Treating pain caused by epiglottitis
For treatment of fever and pain, group of drugs called Nonsteroidal anti-inflammatory drugs or NSAIDs may be given.
These include Acetaminophen, Ibuprofen, Diclofenac, Aspirin etc. These agents reduce fever, soreness and pain.
After the patient is stabilized and the inflammation is reduced the tube is removed.
Prevention of epiglottitis
As a preventive measure all babies need to be vaccinated against Haemophilus influenza type b at age two, three, four and 12 months.
Close contacts of someone who has been diagnosed with epiglottitis are also usually given antibiotics to prevent spread and development of the infection.
Good hygiene measures like hand washing, covering the nose and mouth while coughing and sneezing and isolation of infected persons are important in prevention of epiglottitis.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
What is epiglottitis?