Epiglottitis is a life-threatening medical emergency characterized by inflammation of the epiglottis, the small flap of cartilage at the base of the tongue that prevents aspiration during swallowing. When swollen, the epiglottis can rapidly obstruct the airway, leading to severe respiratory distress. Once a leading cause of pediatric emergencies, its incidence has dramatically decreased due to widespread vaccination against Haemophilus influenzae type B (Hib).
What is the Epiglottis?
The epiglottis is a leaf-shaped piece of elastic cartilage located behind the tongue, at the entrance of the larynx.
Function:
- Acts as a protective barrier by covering the trachea during swallowing.
- Prevents aspiration of food and fluids into the respiratory tract.
When inflamed, the epiglottis swells, narrowing the airway and causing upper airway obstruction.
Pathophysiology of Epiglottitis
- Infection or injury causes acute inflammation of the epiglottis and surrounding supraglottic tissues.
- Swelling progressively obstructs airflow into the trachea and lungs.
- Airway obstruction is worsened by anxiety, crying, or lying supine.
- Without intervention, the child may develop hypoxia, respiratory arrest, and death.
Causes of Epiglottitis
The condition is most often infectious, but can also be due to trauma or irritants.
Most common infectious cause (historically):
- Haemophilus influenzae type B (Hib) – now rare in countries with routine Hib vaccination.
Other bacterial causes:
- Streptococcus pneumoniae
- Streptococcus pyogenes
- Staphylococcus aureus
- Thermal injury (e.g., hot liquids)
- Caustic ingestion
- Direct trauma to the throat
Signs and Symptoms of Epiglottitis
The hallmark of epiglottitis is rapid progression from sore throat to severe airway compromise.
Early Symptoms:
- Severe sore throat
- Painful swallowing (dysphagia)
- High fever
- Restlessness and irritability
Progressive Symptoms:
- Drooling – due to difficulty swallowing
- Tripod position – sitting forward with chin thrust out and mouth open to ease breathing
- Difficulty speaking – muffled or absent voice
- Inspiratory stridor – high-pitched, frog-like croak
- Tachycardia and agitation
- Chest retractions and nasal flaring – signs of respiratory distress
- Absent cough – differentiates epiglottitis from croup
Key clinical pearl: If epiglottitis is suspected, never attempt to examine the throat with a tongue depressor, as this can trigger reflex laryngospasm and complete airway obstruction.
Diagnosis
Epiglottitis is primarily a clinical diagnosis, but certain investigations support confirmation:
- History & Clinical Examination – Rapid onset of sore throat, drooling, stridor, tripod position.
- Lateral Neck X-ray – May show the “thumb sign” (enlarged epiglottis).
- Flexible nasopharyngoscopy – Performed by specialists in controlled settings.
- Blood cultures & swabs – For identifying bacterial pathogens.
Treatment and Emergency Management
Epiglottitis requires immediate emergency intervention to secure the airway.
Airway Management
- Emergency intubation may be required.
- Tracheostomy may be needed if intubation fails.
- Oxygen therapy should be provided with caution (avoid upsetting the child).
Medications
- IV Antibiotics – Broad-spectrum coverage (e.g., ceftriaxone, cefotaxime).
- Corticosteroids – Reduce inflammation.
- Antipyretics – For fever management.
- IV fluids – For hydration, especially in dehydrated children.
Nursing Management
Nurses play a critical role in preventing airway compromise and providing supportive care:
- Never leave the patient unattended – airway obstruction can occur suddenly.
- Assess oxygenation – monitor oxygen saturation continuously.
- Ensure IV access – for emergency medication and fluids.
- Avoid supine position – child should remain in the tripod position.
- Calm environment – keep parents close, do not restrain the child, minimize crying.
- Prepare for emergency intubation – have airway equipment ready.
- NPO (nil per os) – no oral intake to prevent aspiration.
- Provide emotional support to the family.
Complications of Epiglottitis
If untreated, epiglottitis may lead to:
- Complete airway obstruction
- Hypoxia and respiratory failure
- Sepsis and systemic infection
- Death within hours
Prevention
- Hib Vaccination – Routine childhood immunization has drastically reduced incidence in developed countries.
- General Hygiene – Preventing spread of bacterial infections reduces risk.
- Avoiding throat trauma – Educating parents on preventing hot liquid injuries.
Key Points in a Table
| Feature | Epiglottitis |
|---|---|
| Definition | Inflammation of the epiglottis leading to airway obstruction |
| Most Common Cause | Haemophilus influenzae type B (pre-vaccination era) |
| Hallmark Symptoms | Drooling, tripod position, muffled voice, stridor |
| Dangerous Sign | Absent cough + severe respiratory distress |
| Diagnosis | Clinical suspicion, “thumb sign” on X-ray |
| Treatment | Airway management + IV antibiotics + corticosteroids |
| Nursing Role | Never leave patient, maintain calm, monitor airway, avoid supine position |
| Prevention | Hib vaccination |
Frequently Asked Questions (FAQ)
Q1. How is epiglottitis different from croup?
Croup is caused by viral infections, presents with a barking cough, and usually has a slower onset. Epiglottitis is bacterial, rapidly progressive, and does not produce a cough.
Q2. Why should a throat exam be avoided in suspected epiglottitis?
Using a tongue depressor can induce reflex laryngospasm, causing sudden airway obstruction.
Q3. Can adults get epiglottitis?
Yes. Though rare, adults can develop epiglottitis, often presenting with sore throat, drooling, and stridor.
Q4. What is the best prevention for pediatric epiglottitis?
Routine Hib vaccination is the most effective preventive strategy.
Q5. What is the prognosis after treatment?
With timely airway management and antibiotics, prognosis is excellent. Mortality is rare in vaccinated populations with access to emergency care.
