Epiglottitis

Epiglottitis is a bacterial infection of the epiglottis.

The epiglottis is a small flap of stiff tissue that closes the entrance to the voice box (larynx) and windpipe (trachea) during swallowing. Sometimes, the epiglottis becomes infected with bacteria, usually Haemophilus influenzae. The infection is most common in children, but routine vaccination against Haemophilus has recently made this organism less common. The swelling produced by this infection may block the airway and lead to difficulty breathing and death. Because children have a smaller airway than adults, epiglottitis is more dangerous in children (see Section 23, Chapter 272).

Symptoms are severe throat pain, fever, and a muffled voice. Because the infection is in the epiglottis, the back of the throat often does not appear infected. As swelling of the epiglottis starts to narrow the airway, the person first begins to make a squeaking noise when breathing in (stridor) and then has progressively worse trouble breathing. The condition progresses rapidly.

A doctor suspects the diagnosis based on the person's symptoms. If the person is not having trouble breathing, the doctor may look down the throat with a mirror or take x-rays, which often show the swollen epiglottis. Sometimes the doctor looks down the throat with a thin, flexible viewing tube inserted through the nose (nasopharyngeal laryngoscopy).

A person without difficulty breathing is given antibiotics and is closely observed in an intensive care unit. If the person has difficulty breathing, doctors insert a plastic breathing tube through the mouth or nose into the trachea (endotracheal intubation). The tube keeps the airway from swelling shut. Sometimes the airway is so swollen that the doctor cannot insert a tube this way and must cut open the front of the neck and insert the tube directly into the trachea (tracheotomy or cricothyroidotomy).