What is the epiglottis?
The epiglottis sits at the very end of the tongue and covers the voice cords and wind pipe during swallowing, thus preventing food from entering these structures. During breathing, the epiglottis is held in a more upright position to led air pass into the windpipe.
What is an infection of the epiglottis?
An infection of the epiglottis is a rare disease in developed countries that occurs at a frequency of 10-40 cases per million people per year in the United States. It can quickly become very dangerous and therefore requires hospitalization. Infection of the epiglottis can happen in children and in adults, but it is slightly different in these two populations. Most adults with an infection of the epiglottis are between 20 and 40 years old, while children usually get this disease between the age of 2 and 7 with a peak in frequency in children between 2 and 4. It is very rare in very young children under the age of one and has not been observed in Navajo Indians and Eskimos at all.
What can cause an infection of the epiglottis?
An infection of the Epiglottis can be caused by a number of different bacteria, and also by certain viruses, and fungi. The most common cause used to be an infection with the bacterium Hemophilus influenzae type B, or Hib. Widespread vaccinations against Hib, however, have made this disease increasingly rare in the US since the late 1980s. Other organisms that can cause an infection of the epiglottis are bacteria like certain Streptococcus species, in particular Streptococcus pneumonia, Staphylococcus aureus, including methicillin resistant varieties of Staphylococcus aureus also know as MRSA, and certain viruses like varicella-zoster, herpes simplex virus type 1, and certain fungi.
What are the symptoms of an infection of the epiglottis?
The symptoms of an infection of the epiglottis can differ from patient to patient. A common symptom is a sore throat and difficulty swallowing. Infection of the epiglottis can also cause difficulty breathing (respiratory distress) and even respiratory arrest (the patient stops breathing altogether), which can quickly lead to death by suffocation. Difficulty breathing and trouble with swallowing causes most of the other observable symptoms of an infection of the epiglottis. The patients often display a specific posture that is called the sniffing posture in which they lean forward with the shoulders and neck pointing forward and the head pointing upward, as if sniffing for a good smell in the air. This posture is assumed to increase the airway opening that is partially blocked by the infected and swollen epiglottis. Patients can also display drooling as a symptom of the extreme difficulty or inability in swallowing. A high fever is usually seen in children, but in adults the temperature often stays below 100 oF. A sharp whistling noise while breathing in, medically called inspiratory stridor is also an indicator of an infection of the epiglottis. Other symptoms are a muffled “hot potato” voice like if the patient is trying to speak with a mouthful of hot potatoes, and other difficulties speaking. Restlessness and quick shallow breaths can also be indicators of difficulties with breathing.
Physicians usually differentiate three different categories of an infection of the epiglottis that are most pronounced in this form in adults. The most severe category, called category one is characterized by imminent or actual breathing arrest. This is a medical emergency that requires immediate treatment to prevent the patient from dying of suffocation. Patients have usually been sick only for a short amount of time with the condition rapidly worsening and quickly becoming dangerous. Blood cultures that are used to test for bacteria in the blood, can often find live Hemophilus influenzae Type B. Category 2 shows moderate to severe symptoms and while respiratory arrest in not imminent, there is still a high risk that the symptoms might worsen quickly to the point of airway blockade. This is why hospitalization is mandatory for this condition.
How is an infection of the epiglottis treated?
The symptoms of patients in this category are usually inability to swallow, hence show severe drooling, have difficulty with speaking, and a whistling sound is present at inhaling. The patients also have difficulty or inability in lying flat, which are all signs of partial airway blockage. Other signs seen in patients who belong in this fairly severe category that can easily slip into the life-threatening situation that is described as category 1, is the pulling in of muscles in the neck and between the rips upon inhaling. The patients usually try to compensate for the increased airway resistance by using auxiliary muscles for breathing in the neck, chest, and abdomen that are usually not necessary for breathing. A more mild form called category 3 does not have any signs of partial airway blockage. In these patients difficulty swallowing and sore throat are the dominant symptoms.
Since an infection of the epiglottis can go from fairly mild symptoms of sore throat and difficulty swallowing to a life-threatening airway blockage in very little time, immediate hospitalization is required whenever an infection of the epiglottis is suspected or diagnosed. If the airway is not completely blocked, humidified oxygen therapy is usually applied. It is important that the patient is kept as comfortable as possible, especially in children, as anxiety can precipitate an episode of acute airway blockage. Children are therefore usually placed in a dark room in the presence of their parents. IV fluids might be helpful as adjunct therapy. Antibiotics, also given IV, can control the infection, if it is caused by bacteria. In cases of a complete airway blockage a cricothyrotomy, a small incision below the larynx to insert a breathing tube directly into the windpipe, might be necessary to save the patient’s life.