-IBIS-1.5.0-
tx
eyes/ears/nose/throat
epiglottitis
diagnoses

definition and etiology

definition: A severe, rapidly progressing infection of the epiglottis and surrounding tissues that can be rapidly fatal due to abrupt respiratory obstruction by the inflamed epiglottis. This is an acute emergency and should be referred immediately for hospitalization. Do not attempt to visualize the epiglottis if you suspect this condition.

etiology: The associated microorganism is almost always Hemophilus influenza type B. Although the disease may occur at any age, it is most common in children of 2-5, and rarely seen under 2 years of age.

In adults, men are three times more likely as women to develop the disease. Usually, the adult has a predisposing factor, such as immunosuppression, Hodgkin's disease, or multiple myeloma.

signs and symptoms

Onset is extremely acute and intense: typically the child appears well then suddenly develops symptoms:
• high fever
• sore throat
• hoarseness
• dysphagia and acute respiratory distress: drooling; tachypnea; inspiratory stridor; dyspnea; urgent use of suprasternal/supraclavicular/intercostal/subcostal muscles to breathe; wheezes; decreased breath sounds bilaterally
• pharynx deeply inflamed
• swollen, enlarged epiglottis, often visible in the back of the throat: epiglottis is "beefy" red, stiff, and may be coated with secretions
• patients with epiglottitis will often lean forward from the waist in a characteristic posture designed to hold the epiglottis forward, away from the airway; they are likely to resist any attempt to make them lie supine

physical examination:
Visualizing the epiglottis is diagnostic but very dangerous in an out-patient setting because of the risk of sudden, complete obstruction of the airway. Do not, therefore, risk a view of the oropharynx outside a hospital setting.

lab findings:
• culture blood and throat in in-patient setting; H. influenzae is most common pathogen cultured, may also be Strep or Pneumococcus
• X-rays reveal swollen epiglottis
• increased PMNs

course and prognosis

Epiglottitis is a medical emergency. Hospitalization to maintain an open airway is essential and antibiotic therapy must be initiated. Airway obstruction will be fatal in the absence of facilities to treat it.

differential diagnosis

• viral croup
• pharyngitis
• diphtheria
• peritonsillar abscess


footnotes