Epiglottitis

Epiglottitis Essentials - Fiery Throat Peril

• Definition: Acute inflammation of epiglottis & supraglottic structures, potentially causing life-threatening airway obstruction.
• Etiology:
  • Historically: Haemophilus influenzae type b (Hib) - incidence ↓ with vaccination.
  • Currently (vaccinated/adults): Streptococcus pneumoniae, Staphylococcus aureus, Group A Streptococcus, viruses, fungi, thermal injury.
• Pathogenesis: Infection/insult → rapid, severe edema & erythema of epiglottis, aryepiglottic folds, arytenoids → airway narrowing.

⭐ In unvaccinated children, H. influenzae type b (Hib) remains the primary cause; in vaccinated populations, Streptococcus spp. and S. aureus are more frequent culprits of epiglottitis in adults and children alike.

Symptom Spotlight - Distress Signals

• Rapid, fulminant onset (hours) with high fever, severe sore throat.
• 📌 The 4 D's are key:
  • Dysphagia: Painful swallowing, leading to refusal to eat/drink.
  • Drooling: Unable to manage oral secretions.
  • Distress: Respiratory distress, anxiety, air hunger.
  • Dysphonia: Voice change, often muffled.
• Inspiratory stridor: Often a late, alarming sign of airway compromise.
• Tripod posture: Patient sits upright, leans forward, neck extended, chin out.

⭐ Muffled voice, often termed 'hot potato voice', is characteristic.

Diagnostic Detective - Unmasking the Culprit

• Direct Laryngoscopy (Definitive):
  • Best performed in OR/controlled setting, especially in children.
  • Shows 'cherry-red', swollen, oedematous epiglottis.
• Lateral Neck X-ray:
  • Classic 'thumb sign' (swollen epiglottis).
  • Thickened aryepiglottic folds, obliterated vallecula.
• Blood cultures: May identify pathogen (e.g., Hib).
• CBC: ↑ WBC count.

⭐ Avoid routine oral examination with a tongue depressor in children with suspected epiglottitis outside a controlled setting (e.g., OR) due to risk of precipitating acute airway obstruction.

Airway & Action - Lifesaving Moves

• Immediate Goal: Secure airway. Keep patient calm, upright; avoid upsetting maneuvers.
• Team Alert: Senior ENT, Anesthesia, Pediatrics.
• Definitive Airway (OR/ICU):
  • Endotracheal intubation by skilled personnel.
  • Surgical airway (cricothyroidotomy/tracheostomy) if intubation fails/contraindicated.
• Post-Airway Rx:
  • IV Ceftriaxone (e.g., 50-75 mg/kg/day).
  • IV Dexamethasone (e.g., 0.15-0.6 mg/kg).
  • Humidified O2, IV fluids.
• Monitoring: ICU admission for close observation.

⭐ Securing the airway is the foremost priority, often requiring intubation or tracheostomy in a controlled environment like OR.

Beyond the Flare-up - Complications & Shield

• Complications (Rapid & Severe):
  • Airway Obstruction: Hypoxia, anoxic brain injury, death.
  • Epiglottic Abscess: Localized pus; may require incision & drainage.
  • Descending Infection: Pneumonia, mediastinitis, empyema.
  • Systemic Spread: Sepsis, septic shock, meningitis (if bacteremia).
  • Rare: Vocal cord paralysis, post-obstructive pulmonary edema.
• Shield (Proactive Defense):
  • ⭐ > The Haemophilus influenzae type b (Hib) vaccine is primary prevention, dramatically reducing pediatric epiglottitis incidence.
  • Chemoprophylaxis: Rifampicin for unvaccinated close contacts (household, daycare) to eradicate carriage, preventing secondary cases.

High‑Yield Points - ⚡ Biggest Takeaways

• Etiology: Primarily Haemophilus influenzae type b (Hib), though incidence ↓ post-vaccination; also Streptococcus spp.
• Pediatric Triad: Dysphagia, Drooling, Distress; often assumes tripod position.
• Adult Presentation: Severe sore throat (out of proportion), odynophagia, muffled "hot potato" voice.
• Key Sign: Thumbprint sign on lateral neck X-ray is characteristic.
• Definitive Diagnosis: Laryngoscopy (cherry-red, swollen epiglottis), done cautiously.
• Management Priority: Secure airway (intubation/tracheostomy); followed by IV antibiotics (e.g., ceftriaxone).
• Major Complication: Rapidly progressive airway obstruction.