By Dr Ananya Mandal, MD
Epiglottitis is inflammation and swelling of the epiglottis. The epiglottis lies just behind the root of the tongue at the back of the mouth.
What is the epiglottis?
The epiglottis is a leaf-shaped flap of cartilage tissue. Its main function is to flip over the larynx or voice box that guards the entrance of the airways during swallowing. This prevents food from entering into the windpipe.
If the epiglottis is faulty there may be choking by misdirection of the food to the windpipe instead of the food pipe or oesophagus. (1-5)
Causes of epiglottitis
Epiglottitis is usually caused by infection with the bacterium Haemophilus influenzae type b (Hib) and commonly affects children between ages two and seven. However, epiglottitis may affect an individual of any age.
Other bacteria such as Streptococcus pneumoniae can also cause epiglottitis. Infection leads to inflammation and swelling of the epiglottis.
This causes swelling of the epiglottis that may obstruct breathing.
There may be non-infectious causes of epiglottitis. This could include injury from a chemical, hot fluids or from injury to the neck.
Symptoms of epiglottitis
Common features include sore throat, difficulty breathing and fever. High fever is usually the first symptoms.
It may lead to severe obstruction in the airways and choke the patient. There may be pain on swallowing and hoarseness of voice.
Due to difficulty in swallowing there may be drooling of saliva.
Cough is rare but may be present. Breathing may be noisy with grunting sounds.
Those with epiglottitis prefer to sit upright and lean forwards with their tongues out. This position helps to open up their airway to let more oxygen through to the lungs.
If there is lack of oxygen in blood skin color changes to become grey or blue. This is called cyanosis.
Treatment of epiglottitis
If epiglottitis is treated quickly with enough oxygen can reach the lungs and antibiotics, the outcome is good.
Untreated, epiglottitis may be life-threatening. It is diagnosed using X ray and other imaging techniques.
Sometimes epiglottitis can be a complication of croup infection.
Croup is infection of the larynx (voice box) and trachea (windpipe). In these cases the infection from the trachea or larynx spreads to the epiglottis and causes epiglottitis.
Vaccination against cause of epiglottitis
There is a vaccine against Hib for children. This has reduced the number of children infected by this condition dramatically.
The Hib vaccine is advised for all babies at age two, three, four and 12 months. As the use of the Hib vaccine increases, this has meant that the typical person who develops epiglottitis is an adult rather than a child. The risk however is still rare.
People with a depressed immune system like those with HIV AIDS, or those on cancer chemotherapy or steroids and those with diabetes are at increased risk of this infection.
It is estimated that each year in England there is one case of epiglottitis in every 200,000 children, and one case in every 100,000 adults.
Deaths from epiglottitis are rare and occur in less than 1 in 100 cases.
Edited by April Cashin-Garbutt, BA Hons (Cantab)