Epiglottitis
From Medical-Wiki
Epiglottitis is an inflammation of the epiglottis. The epiglottis serves to cover the larynx during swallowing. It is a small piece of cartilage, covered with mucous membrane that sits at the base of the thumb. Because the structure sits at the narrowest part of the airway, any swelling in the epiglottis has a potential for significant respiratory distress.
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Demographic differences in epiglottitis
Because the absolute diameter of the airway is smaller in children, epiglotittis is a greater problem in this population, but adults may have serious disease as well.
Adult epiglotittis differs from pediatric disease in that the onset is more insidious—sometimes lasting as long as 7 days. There are also not as many obvious signs of the disease. In one series, a number of patients had seen physicians prior to the episode of obstruction and diagnosed with pharyngitis. Stridor and pooling of saliva have been reported as being the most common clinical indications of the disease. Cultures revealed a variety of organisms without one that predominated.
Etiology of epiglottitis
The Hib vaccine for Haemophilus influenzae type b in 1985 has significantly lowered the incidence of epiglotittis. However, other organisms such as group A, B, and C Streptococcus; Streptococcus pneumoniae; Klebsiella pneumoniae; Candida albicans; Staphylococcus aureus; Haemophilus parainfluenzae; Neisseria meningitidis; varicella zoster; and several other viruses are capable of causing epiglotittis—just not with as great a frequency or as accelerated a course as “H. flu.”
There are non-infectious causes of epiglotittis including burns, ingestion of caustic agents, and foreign bodies. Crack cocaine can also cause a caustic reaction that can be severe. Recently, ace inhibitors have been implicated in severe angioneurotic edema that in some cases have been fatal. It should be noted that some of these reactions have occurred months after patients have been on the medication.
Morbidity & Mortality in epiglottitis
Mortality rates are indicative of the importance of intervention. The mortality rate approaches zero in those centers where there are established protocols. Morbidity rates in these centers are only 4%. When diagnosis is delayed, there is a mortality rate as high as 18%. Management of patients has a mortality rate as high as 6%. [1]
Clinical presentation
When a child presents with suspected epiglotittis, they may have little or no cough, appear to be anxious and irritable. Their voice may be thick or hoarse. Drooling is often apparent and they may complain of being unable to swallow. Stridor is a sign of considerable concern.
A clinical impression is crucial because any attempt at visualizing the epiglottis is terribly risky. Before such an attempt is even considered, airway control should be established in the form of an anesthesiologist or someone highly skilled in intubation, as well as immediate access to appropriate equipment. [2]
Diagnosing epiglottitis
Radiological findings
X-rays of the neck may be helpful—demonstrating the classic “thumb” appearance.
Treatment of epiglottitis
Initial treatment must be directed at establishing and maintaining an adequate airway. Broad spectrum antibiotics may be initiated prior to culture results being returned. These should be a second or third generation cephalosporin. The child may be extubated on an elective basis upon improvement. [3]
