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November 27, 2025
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Background
Epiglottitis, also known as supraglottitis is a severe condition characterized by the inflammation and swelling of the epiglottis, a flap of cartilage located at the base of the tongue, which helps prevent food and fluids from entering the windpipe (trachea) during swallowing. This condition can obstruct the airway and cause severe respiratory distress, making it a medical emergency.
Historically, epiglottitis was primarily caused by infection with Haemophilus influenzae type b (Hib) bacteria. However, with the introduction of Hib vaccination, the incidence of Hib-related epiglottitis has significantly declined. Non-typeable Haemophilus influenzae (NTHi), Streptococcus pneumoniae, and other bacterial or viral pathogens are more commonly associated with epiglottitis.
Epidemiology
Epiglottitis has undergone significant changes in epidemiology, primarily due to the introduction of the Haemophilus influenzae type b (Hib) vaccine. Before widespread vaccination, Hib was the predominant cause of epiglottitis in children and adults. Here is an overview of the epidemiology of epiglottitis:
Pre-Hib Vaccine Era:Â
Incidence: Before introducing the Hib vaccine, the annual incidence of epiglottitis in children ranged from 1 to 8 cases per 100,000 children. The incidence was lower in adults, ranging from 0.5 to 1.8 cases per 100,000 adults.
Age Distribution: Epiglottitis primarily affects children between the ages of 2 and 6 years, with a peak incidence around 3-4 years. However, it could occur in individuals of any age, including adults.
Causative Pathogen: Hib was responsible for most cases, accounting for approximately 80-95% of pediatric epiglottitis and a significant proportion in adults.
Post-Hib Vaccine Era:
Impact of Hib Vaccine: The introduction of the Hib conjugate vaccine in the late 1980s and early 1990s dramatically reduced the incidence of Hib-related epiglottitis. Hib vaccine coverage has led to a decline of over 90% in Hib-associated invasive diseases, including epiglottitis.
Changing Pathogens: With the decrease in Hib-related cases, non-typeable Haemophilus influenzae (NTHi) has emerged as the leading cause of epiglottitis in the post-Hib vaccine era. Other bacterial pathogens, such as Streptococcus pneumoniae, Staphylococcus aureus, and group A Streptococcus, as well as viral causes, have also been implicated.
Anatomy
Pathophysiology
Infection or Inflammation Trigger: In the pre-vaccine era, Haemophilus influenzae type b (Hib) was the predominant causative bacterium. However, with the widespread use of the Hib vaccine, non-typeable Haemophilus influenzae (NTHi) and other bacterial or viral pathogens have become more common causes.
Inflammatory Response: The infectious agent or other inflammatory triggers initiate an immune response. In the case of infectious causes, the pathogen invades the tissues of the epiglottis, leading to an immune response aimed at eliminating the infection.
Edema and Swelling: Inflammatory mediators and immune cell activation cause increased permeability of blood vessels in the affected area. This results in fluid leakage into the tissues of the epiglottis, leading to edema (swelling).
Airway Obstruction: The epiglottis typically covers the opening of the larynx (voice box) during swallowing, preventing food and fluids from entering the airway. However, with significant edema and swelling, the enlarged epiglottis obstructs the airway, potentially leading to respiratory distress and compromised breathing.
Respiratory Distress: As the airway becomes progressively obstructed, individuals with epiglottitis may experience symptoms of respiratory distress due to inadequate oxygenation.
Etiology
The specific etiology can vary depending on the individual’s age group and immunization status. Here are some critical etiological factors:
Haemophilus influenzae type b (Hib): Before introducing the Hib vaccine, Hib was the leading cause of epiglottitis, particularly in children. However, with widespread vaccination, the incidence of Hib-related cases has significantly decreased.
Non-Typeable Haemophilus influenzae (NTHi): NTHi has emerged as the most common bacterial cause of epiglottitis, affecting children and adults.
Streptococcus pneumoniae: Pneumococcal bacteria can occasionally cause epiglottitis, especially in older children and adults.
Other Bacterial Pathogens: Rarely, other bacteria like Staphylococcus aureus or group A Streptococcus (Streptococcus pyogenes) can be associated with epiglottitis.
Viral pathogens, such as influenza viruses, parainfluenza viruses, adenoviruses, and respiratory syncytial virus (RSV), can cause inflammation and swelling of the epiglottis, leading to epiglottitis in some cases. Viral-induced epiglottitis is more common in children.
Thermal Burns: In rare instances, thermal burns from hot liquids or corrosive substances can cause severe inflammation and swelling of the epiglottis, leading to epiglottitis.
Allergic Reactions: In rare cases, severe allergic reactions (anaphylaxis) can cause swelling of the epiglottis, resulting in a clinical presentation like infectious epiglottitis.
Genetics
Prognostic Factors
Age: Younger children, particularly those under 5, are historically at higher risk of severe complications and poorer outcomes. This is partly due to the relatively smaller size of their airways, which can lead to more rapid and severe airway obstruction in the presence of epiglottitis.
Vaccination Status: The widespread use of the Haemophilus influenzae type b (Hib) vaccine has significantly impacted the prognosis of epiglottitis. Hib vaccination has dramatically reduced the incidence of Hib-related epiglottitis and its associated complications.
Timely Medical Intervention: Immediate medical attention, including securing the airway if necessary, administering appropriate antibiotics, and providing supportive care, can significantly improve the prognosis.
Presence of Complications: Some individuals with epiglottitis may develop complications, such as respiratory failure, sepsis, or pneumonia.
Pathogen Type: The pathogen causing epiglottitis can influence the severity and prognosis. While non-typeable Haemophilus influenzae (NTHi) is the most common cause of epiglottitis in the post-Hib vaccine era, other bacteria or viral pathogens can also contribute.
Coexisting Medical Conditions: The presence of underlying medical conditions or comorbidities, such as immunodeficiency disorders or chronic respiratory conditions, can increase the risk of complications and affect the prognosis.
Timeliness of Antibiotic Treatment: Appropriate antibiotic therapy is crucial in managing epiglottitis of bacterial origin. Timely initiating appropriate antibiotics targeting the causative pathogen can help control the infection, reduce inflammation, and improve the prognosis.
Clinical History
Age Group: Epiglottitis can occur in individuals of any age, but there are variations in its clinical presentation based on age.
Children: Epiglottitis is more commonly seen in children, with a peak incidence between 2 and 6 years of age.
Adults: The presentation may be less severe in adults and have a more gradual onset than in children.
Associated Comorbidity or Activity: Certain factors may be associated with an increased risk of developing epiglottitis or influencing its severity. These include:
Immunization Status: Individuals who have not received the Haemophilus influenzae type b (Hib) vaccine or have incomplete immunization may be at higher risk, especially in children.
Smoking: Smoking can increase the risk and severity of epiglottitis.
Comorbidities: Underlying conditions, such as immunodeficiency disorders or chronic respiratory conditions, may predispose individuals to develop more severe forms of epiglottitis.
Physical Examination
General Appearance: Evaluate the patient’s overall appearance and behavior. Patients with epiglottitis may appear anxious, distressed, or in respiratory distress.
Vital Signs: Measure vital signs, including heart rate, respiratory rate, blood pressure, and oxygen saturation. Tachycardia (rapid heart rate) and tachypnea (rapid breathing) may be present.
Respiratory Assessment:
Observe for signs of respiratory distress, such as increased work of breathing, use of accessory muscles, nasal flaring, and intercostal retractions.
Listen for abnormal breathing sounds, including stridor (high-pitched inspiratory noise) and decreased breath sounds, indicating airway obstruction.
Neck Examination:Â
Inspection: Observe the neck for any visible swelling or fullness.
Palpation: Gentle palpation of the neck may reveal tenderness or swelling.
Oral Cavity and Throat Examination: Inspect the oral cavity for signs of inflammation, such as redness, swelling, or exudate on the tonsils or pharynx. Note any drooling, which can indicate difficulty swallowing.
Avoid Stimulating the Epiglottis: Avoid any actions that may cause stimulation of the epiglottis, such as throat swabs or attempts to visualize the epiglottis directly. These actions may trigger spasms or worsen airway obstruction.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
The acuity of the presentation can vary, but typically the onset of symptoms is sudden and progresses rapidly.
Severe Sore Throat: Individuals with epiglottitis often experience severe throat pain.
Dysphagia: Difficulty swallowing and a refusal to eat or drink are common due to the obstructed airway.
Respiratory Distress: As the epiglottis swells and obstructs the airway, individuals may exhibit signs of respiratory distress, such as high-pitched breathing sounds (stridor), rapid and labored breathing, retractions (pulling in of the chest wall), and cyanosis (bluish discoloration of the skin) due to inadequate oxygenation.
Fever: Elevated body temperature is common and may be accompanied by other signs of systemic inflammation.
Drooling: Difficulty swallowing can lead to excessive drooling, especially in children.
Differential Diagnoses
Croup (Laryngotracheobronchitis): Croup is a viral infection that causes upper airway inflammation, including the larynx and trachea. It typically affects children and presents with symptoms like epiglottitis, such as stridor, barking cough, and respiratory distress.
Retropharyngeal Abscess: This is a deep neck infection that can present with symptoms like epiglottitis. It involves the infection and abscess formation in the space behind the pharynx. Retropharyngeal abscess can cause difficulty swallowing, sore throat, fever, and respiratory distress.
Peritonsillar Abscess: Also known as quinsy, it is a localized collection of pus behind the tonsils. Peritonsillar abscess can cause severe throat pain, difficulty swallowing, and fever. Although the symptoms may overlap with epiglottitis, there is usually a visible asymmetrical swelling on examination, and the absence of significant respiratory distress helps distinguish it from epiglottitis.
Angioedema: Angioedema is swelling beneath the skin due to an allergic or non-allergic reaction. It can affect the airway and cause symptoms like epiglottitis, such as throat swelling, difficulty breathing, and stridor.
Foreign Body Aspiration: In children, aspiration of a foreign body into the airway can cause sudden airway obstruction and respiratory distress. This can present similarly to epiglottitis.
Acute Allergic Reaction: An acute severe allergic reaction, known as anaphylaxis, can cause rapid-onset airway swelling and compromise. It can present with symptoms resembling epiglottitis, including difficulty breathing, throat swelling, and stridor.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Croup (Laryngotracheobronchitis): Croup is a viral infection that causes upper airway inflammation, including the larynx and trachea. It typically affects children and presents with symptoms like epiglottitis, such as stridor, barking cough, and respiratory distress.
Retropharyngeal Abscess: This is a deep neck infection that can present with symptoms like epiglottitis. It involves the infection and abscess formation in the space behind the pharynx. Retropharyngeal abscess can cause difficulty swallowing, sore throat, fever, and respiratory distress.
Peritonsillar Abscess: Also known as quinsy, it is a localized collection of pus behind the tonsils. Peritonsillar abscess can cause severe throat pain, difficulty swallowing, and fever. Although the symptoms may overlap with epiglottitis, there is usually a visible asymmetrical swelling on examination, and the absence of significant respiratory distress helps distinguish it from epiglottitis.
Angioedema: Angioedema is swelling beneath the skin due to an allergic or non-allergic reaction. It can affect the airway and cause symptoms like epiglottitis, such as throat swelling, difficulty breathing, and stridor.
Foreign Body Aspiration: In children, aspiration of a foreign body into the airway can cause sudden airway obstruction and respiratory distress. This can present similarly to epiglottitis.
Acute Allergic Reaction: An acute severe allergic reaction, known as anaphylaxis, can cause rapid-onset airway swelling and compromise. It can present with symptoms resembling epiglottitis, including difficulty breathing, throat swelling, and stridor.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
use-of-non-pharmacological-approach-for-treating-epiglottitis
Non-pharmacological approaches play a limited role in the immediate treatment of epiglottitis (supraglottitis), as this condition requires prompt medical intervention to secure the airway and administer appropriate antibiotics. The non-pharmacological approaches that can be considered are:
Airway Management Techniques: Non-pharmacological measures can help maintain a patent airway and facilitate breathing. These may include:
Positioning: Keeping the patient upright can help improve airway patency and reduce the risk of airway obstruction.
Humidification: Providing humidified air or supplemental oxygen can help soothe the airway and relieve symptoms of inflammation.
Nebulized Epinephrine: Nebulized epinephrine may be used in some cases to reduce airway swelling and alleviate respiratory distress.
Supportive Care: Non-pharmacological supportive measures can assist in the patient’s comfort and recovery. These may include:
Fluids and Nutrition: Adequate hydration and nutrition are essential for recovery. Intravenous fluids may be administered if swallowing is difficult or unsafe.
Rest and Comfort: Providing a calm and quiet environment can help reduce stress and promote healing. Rest and sleep are also crucial for recovery.
Monitoring: Regular monitoring of vital signs, including oxygen saturation and respiratory rate, ensures early detection of changes in the patient’s condition.
Psychological Support: Epiglottitis can be a frightening experience for patients, particularly children. Providing emotional support and reassurance can help alleviate anxiety and promote healing.
Role of antibiotics in the treatment of Epiglottitis
The primary treatment for epiglottitis (supraglottitis) involves the administration of appropriate pharmaceutical agents, specifically antibiotics, to target the underlying bacterial infection. The choice of antibiotics is based on the likely causative pathogens and local antibiotic susceptibility patterns. The commonly used drugs for the treatment of epiglottitis are:
Third-generation Cephalosporins: Cephalosporins are the first-line antibiotics for epiglottitis due to their efficacy against the most common pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae. Third-generation cephalosporins, including cefotaxime and ceftriaxone, are frequently used due to their broad spectrum of activity and good tissue penetration.
Ampicillin/Sulbactam: This combination antibiotic may be an alternative to third-generation cephalosporins, particularly in patients with a history of beta-lactam allergy.
Piperacillin/Tazobactam: Another alternative antibiotic regimen, piperacillin/tazobactam, may be used in cases where a broader spectrum of activity is desired or if there is a concern for potential resistance.
Vancomycin is the anti staphylococcal agent of choice in patients with epiglottitis complicated by sepsis, those with concomitant meningitis, or those from areas with an increased prevalence of clindamycin-resistant methicillin-resistant S aureus
The Crucial Role of Antibiotics in Eradicating Infection, Reducing Inflammation, and Preventing Complications
The primary treatment for epiglottitis (supraglottitis) involves the administration of appropriate pharmaceutical agents, specifically antibiotics, to target the underlying bacterial infection. The choice of antibiotics is based on the likely causative pathogens and local antibiotic susceptibility patterns. The commonly used drugs for the treatment of epiglottitis are:
Third-generation Cephalosporins: Cephalosporins are the first-line antibiotics for epiglottitis due to their efficacy against the most common pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae. Third-generation cephalosporins, including cefotaxime and ceftriaxone, are frequently used due to their broad spectrum of activity and good tissue penetration.
Ampicillin/Sulbactam: This combination antibiotic may be an alternative to third-generation cephalosporins, particularly in patients with a history of beta-lactam allergy.
Piperacillin/Tazobactam: Another alternative antibiotic regimen, piperacillin/tazobactam, may be used in cases where a broader spectrum of activity is desired or if there is a concern for potential resistance.
Vancomycin is the anti staphylococcal agent of choice in patients with epiglottitis complicated by sepsis, those with concomitant meningitis, or those from areas with an increased prevalence of clindamycin-resistant methicillin-resistant S aureus
Role of Parenteral glucocorticoids and bronchodilators used as adjunctive treatments for patients with epiglottitis
Bronchodilators, commonly used in conditions such as asthma or chronic obstructive pulmonary disease (COPD), are not indicated in treating epiglottitis. The obstruction in epiglottitis occurs at the supraglottic level, involving the epiglottis and upper airway, rather than the lower airways targeted by bronchodilators.
Similarly, while glucocorticoids may have anti-inflammatory effects and are used in various respiratory conditions, their role in treating epiglottitis is limited. The primary treatment for epiglottitis involves antibiotics to target bacterial infection and reduce airway inflammation. Glucocorticoids are not routinely recommended as adjunctive therapy for epiglottitis, and their use remains controversial.
Dexamethasone: Dexamethasone is a potent corticosteroid with anti-inflammatory and immunosuppressive properties. dexamethasone helps reduce inflammation and swelling of the epiglottis, improving symptoms, and facilitating healing. It is typically administered intravenously (IV) or intramuscularly (IM) in the hospital setting. An initial bolus dose of 4 to 10 mg of dexamethasone is given, followed by a repeated IV dose of 4 mg every 6 hours. The dosage may vary depending on the severity of the condition and individual patient factors. Close observation of the airway is essential during treatment.
Budesonide Inhaled: budesonide is an inhaled corticosteroid primarily used to treat respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). However, in cases of epiglottitis, if the airway is secure and the inflammation is localized to the epiglottis, nebulized or inhaled budesonide may be considered an adjunctive treatment.
Role of analgesics in patients with epiglottitis
Analgesics, precisely non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (paracetamol), can play a supportive role in the treatment of epiglottitis (supraglottitis). While these medications do not directly treat the underlying infection, they can help manage symptoms and improve patient comfort. Here’s the role of analgesics in the treatment of epiglottitis:
Pain Relief: Epiglottitis often presents with severe throat pain, which can cause significant discomfort for patients. Analgesics can help alleviate this pain and improve the individual’s overall well-being. Reduced pain can make swallowing and breathing less distressing, facilitating oral intake and maintaining hydration.
Fever Reduction: Epiglottitis is commonly associated with fever. NSAIDs and acetaminophen effectively reduce fever, which can relieve and help restore the patient’s normal body temperature. By reducing fever, analgesics may also contribute to improved comfort and overall well-being.
Anti-inflammatory Effects: NSAIDs, such as ibuprofen or naproxen, have anti-inflammatory properties. They can help reduce inflammation in the throat and surrounding tissues, easing swelling and improving symptoms. However, it’s important to note that the primary treatment for epiglottitis is antibiotic therapy to address the underlying bacterial infection, and analgesics should be used as adjunctive therapy.
use-of-intervention-with-a-procedure-in-treating-epiglottitis
In cases of severe airway compromise or impending airway obstruction due to epiglottitis (supraglottis), various procedures may be performed to secure the airway and provide immediate relief. These interventions are typically performed by healthcare professionals experienced in airway management, such as emergency medicine physicians or otolaryngologists. Here are some procedures that can be used for the treatment of epiglottitis:
Endotracheal Intubation: Endotracheal intubation involves the insertion of a tube into the trachea through the mouth or nose to establish a secure airway. It is performed using a laryngoscope or with the assistance of video laryngoscopy. Endotracheal intubation allows for mechanical ventilation and ensures a patent airway.
Tracheostomy: It is a surgical procedure in which an incision is made in the neck, and a breathing tube (tracheostomy tube) is inserted directly into the trachea. This bypasses the upper airway obstruction caused by the inflamed epiglottis, providing a secure airway. Tracheostomy is typically reserved for severe airway compromise or failed endotracheal intubation.
Supraglottic Airway Devices: Supraglottic airway devices, such as the laryngeal mask airway (LMA), may be used as a temporary measure to establish a patent airway in cases where endotracheal intubation or tracheostomy is not immediately feasible or indicated. These devices sit above the vocal cords and provide a seal in the hypopharynx, allowing for ventilation and oxygenation.
use-of-phases-in-managing-epiglottitis
The management of epiglottitis typically involves several phases to ensure effective treatment and patient safety. These phases include:
Initial Assessment and Stabilization: The initial phase involves promptly assessing the patient’s airway, breathing, and circulation (ABC) to identify signs of airway compromise or respiratory distress. Airway management is a priority, and interventions such as providing supplemental oxygen and maintaining the patient upright may be initiated. In severe cases, immediate intubation or other airway interventions may be necessary to secure the airway and ensure adequate ventilation.
Diagnostic Evaluation: A comprehensive diagnostic evaluation is conducted once the patient’s airway is secured and stabilized. This evaluation includes a thorough history, physical examination, and appropriate diagnostic tests, such as blood tests and imaging studies (e.g., X-ray, CT scan). The purpose is to identify the underlying cause of epiglottitis, such as bacterial infection, and assess the severity and extent of the inflammation.
Antibiotic Therapy: Early initiation of antibiotic therapy is crucial in managing epiglottitis to target the underlying bacterial infection. Empiric antibiotic treatment is typically initiated based on the likely causative pathogens and local antibiotic susceptibility patterns. Third-generation cephalosporins, such as cefotaxime or ceftriaxone, are commonly used due to their broad spectrum of activity against common pathogens associated with epiglottitis.
Supportive Care and Symptom Management: Supportive care measures aim to alleviate symptoms and promote patient comfort during recovery. Analgesics, such as NSAIDs or acetaminophen, may be prescribed to relieve pain and reduce fever. Adequate hydration and maintaining a humidified environment can help alleviate discomfort and promote airway moisture.
Monitoring and Observation: Closely monitoring the patient’s vital signs, oxygen saturation, and respiratory status is essential. Continuous airway, breathing, and circulation assessment are performed to ensure adequate oxygenation and ventilation. Serial examinations and follow-up imaging may be conducted to monitor the resolution of inflammation and assess the patient’s progress.
Medication
The usual dose for the treatment of epiglottitis is 1 to 4 g via Intravenous or Intramuscular administration twice or thrice a day for up to 7 or 14 days. The duration of the treatment depends on the severity and the nature of the infections
If the infection is severe, the dose can be increased up to 12 g per day
Dose Adjustments
Renal Dose Adjustment
In case of renal insufficiency, the usual dose of ceftizoxime depends on the CrCl. If the CrCl is below 5 mL/min, then 0.25-0.5 g a day or 0.5-1 g via IV or IM in 2 days after undergoing dialysis. Loading dose is standard in renal insufficiency, which is 0.5-1 g. 0.25 -1g twice a day if CrCl falls between 5 and 49 mL/min and 0.5 – 1.5 g thrice a day if CrCl is between 50 and 79 mL/min
Future Trends
References
Epiglottitis.ncbi.nlm.nih
The Changing Epidemiology:ncbi.nlm.nih
Epiglottitis in the Hemophilus.ncbi.nlm.nih
Croup.ncbi.nlm.nih
Medical Management of Epiglottitis.ncbi.nlm.nih
Epiglottitis, also known as supraglottitis is a severe condition characterized by the inflammation and swelling of the epiglottis, a flap of cartilage located at the base of the tongue, which helps prevent food and fluids from entering the windpipe (trachea) during swallowing. This condition can obstruct the airway and cause severe respiratory distress, making it a medical emergency.
Historically, epiglottitis was primarily caused by infection with Haemophilus influenzae type b (Hib) bacteria. However, with the introduction of Hib vaccination, the incidence of Hib-related epiglottitis has significantly declined. Non-typeable Haemophilus influenzae (NTHi), Streptococcus pneumoniae, and other bacterial or viral pathogens are more commonly associated with epiglottitis.
Epiglottitis has undergone significant changes in epidemiology, primarily due to the introduction of the Haemophilus influenzae type b (Hib) vaccine. Before widespread vaccination, Hib was the predominant cause of epiglottitis in children and adults. Here is an overview of the epidemiology of epiglottitis:
Pre-Hib Vaccine Era:Â
Incidence: Before introducing the Hib vaccine, the annual incidence of epiglottitis in children ranged from 1 to 8 cases per 100,000 children. The incidence was lower in adults, ranging from 0.5 to 1.8 cases per 100,000 adults.
Age Distribution: Epiglottitis primarily affects children between the ages of 2 and 6 years, with a peak incidence around 3-4 years. However, it could occur in individuals of any age, including adults.
Causative Pathogen: Hib was responsible for most cases, accounting for approximately 80-95% of pediatric epiglottitis and a significant proportion in adults.
Post-Hib Vaccine Era:
Impact of Hib Vaccine: The introduction of the Hib conjugate vaccine in the late 1980s and early 1990s dramatically reduced the incidence of Hib-related epiglottitis. Hib vaccine coverage has led to a decline of over 90% in Hib-associated invasive diseases, including epiglottitis.
Changing Pathogens: With the decrease in Hib-related cases, non-typeable Haemophilus influenzae (NTHi) has emerged as the leading cause of epiglottitis in the post-Hib vaccine era. Other bacterial pathogens, such as Streptococcus pneumoniae, Staphylococcus aureus, and group A Streptococcus, as well as viral causes, have also been implicated.
Infection or Inflammation Trigger: In the pre-vaccine era, Haemophilus influenzae type b (Hib) was the predominant causative bacterium. However, with the widespread use of the Hib vaccine, non-typeable Haemophilus influenzae (NTHi) and other bacterial or viral pathogens have become more common causes.
Inflammatory Response: The infectious agent or other inflammatory triggers initiate an immune response. In the case of infectious causes, the pathogen invades the tissues of the epiglottis, leading to an immune response aimed at eliminating the infection.
Edema and Swelling: Inflammatory mediators and immune cell activation cause increased permeability of blood vessels in the affected area. This results in fluid leakage into the tissues of the epiglottis, leading to edema (swelling).
Airway Obstruction: The epiglottis typically covers the opening of the larynx (voice box) during swallowing, preventing food and fluids from entering the airway. However, with significant edema and swelling, the enlarged epiglottis obstructs the airway, potentially leading to respiratory distress and compromised breathing.
Respiratory Distress: As the airway becomes progressively obstructed, individuals with epiglottitis may experience symptoms of respiratory distress due to inadequate oxygenation.
The specific etiology can vary depending on the individual’s age group and immunization status. Here are some critical etiological factors:
Haemophilus influenzae type b (Hib): Before introducing the Hib vaccine, Hib was the leading cause of epiglottitis, particularly in children. However, with widespread vaccination, the incidence of Hib-related cases has significantly decreased.
Non-Typeable Haemophilus influenzae (NTHi): NTHi has emerged as the most common bacterial cause of epiglottitis, affecting children and adults.
Streptococcus pneumoniae: Pneumococcal bacteria can occasionally cause epiglottitis, especially in older children and adults.
Other Bacterial Pathogens: Rarely, other bacteria like Staphylococcus aureus or group A Streptococcus (Streptococcus pyogenes) can be associated with epiglottitis.
Viral pathogens, such as influenza viruses, parainfluenza viruses, adenoviruses, and respiratory syncytial virus (RSV), can cause inflammation and swelling of the epiglottis, leading to epiglottitis in some cases. Viral-induced epiglottitis is more common in children.
Thermal Burns: In rare instances, thermal burns from hot liquids or corrosive substances can cause severe inflammation and swelling of the epiglottis, leading to epiglottitis.
Allergic Reactions: In rare cases, severe allergic reactions (anaphylaxis) can cause swelling of the epiglottis, resulting in a clinical presentation like infectious epiglottitis.
Age: Younger children, particularly those under 5, are historically at higher risk of severe complications and poorer outcomes. This is partly due to the relatively smaller size of their airways, which can lead to more rapid and severe airway obstruction in the presence of epiglottitis.
Vaccination Status: The widespread use of the Haemophilus influenzae type b (Hib) vaccine has significantly impacted the prognosis of epiglottitis. Hib vaccination has dramatically reduced the incidence of Hib-related epiglottitis and its associated complications.
Timely Medical Intervention: Immediate medical attention, including securing the airway if necessary, administering appropriate antibiotics, and providing supportive care, can significantly improve the prognosis.
Presence of Complications: Some individuals with epiglottitis may develop complications, such as respiratory failure, sepsis, or pneumonia.
Pathogen Type: The pathogen causing epiglottitis can influence the severity and prognosis. While non-typeable Haemophilus influenzae (NTHi) is the most common cause of epiglottitis in the post-Hib vaccine era, other bacteria or viral pathogens can also contribute.
Coexisting Medical Conditions: The presence of underlying medical conditions or comorbidities, such as immunodeficiency disorders or chronic respiratory conditions, can increase the risk of complications and affect the prognosis.
Timeliness of Antibiotic Treatment: Appropriate antibiotic therapy is crucial in managing epiglottitis of bacterial origin. Timely initiating appropriate antibiotics targeting the causative pathogen can help control the infection, reduce inflammation, and improve the prognosis.
Age Group: Epiglottitis can occur in individuals of any age, but there are variations in its clinical presentation based on age.
Children: Epiglottitis is more commonly seen in children, with a peak incidence between 2 and 6 years of age.
Adults: The presentation may be less severe in adults and have a more gradual onset than in children.
Associated Comorbidity or Activity: Certain factors may be associated with an increased risk of developing epiglottitis or influencing its severity. These include:
Immunization Status: Individuals who have not received the Haemophilus influenzae type b (Hib) vaccine or have incomplete immunization may be at higher risk, especially in children.
Smoking: Smoking can increase the risk and severity of epiglottitis.
Comorbidities: Underlying conditions, such as immunodeficiency disorders or chronic respiratory conditions, may predispose individuals to develop more severe forms of epiglottitis.
General Appearance: Evaluate the patient’s overall appearance and behavior. Patients with epiglottitis may appear anxious, distressed, or in respiratory distress.
Vital Signs: Measure vital signs, including heart rate, respiratory rate, blood pressure, and oxygen saturation. Tachycardia (rapid heart rate) and tachypnea (rapid breathing) may be present.
Respiratory Assessment:
Observe for signs of respiratory distress, such as increased work of breathing, use of accessory muscles, nasal flaring, and intercostal retractions.
Listen for abnormal breathing sounds, including stridor (high-pitched inspiratory noise) and decreased breath sounds, indicating airway obstruction.
Neck Examination:Â
Inspection: Observe the neck for any visible swelling or fullness.
Palpation: Gentle palpation of the neck may reveal tenderness or swelling.
Oral Cavity and Throat Examination: Inspect the oral cavity for signs of inflammation, such as redness, swelling, or exudate on the tonsils or pharynx. Note any drooling, which can indicate difficulty swallowing.
Avoid Stimulating the Epiglottis: Avoid any actions that may cause stimulation of the epiglottis, such as throat swabs or attempts to visualize the epiglottis directly. These actions may trigger spasms or worsen airway obstruction.
The acuity of the presentation can vary, but typically the onset of symptoms is sudden and progresses rapidly.
Severe Sore Throat: Individuals with epiglottitis often experience severe throat pain.
Dysphagia: Difficulty swallowing and a refusal to eat or drink are common due to the obstructed airway.
Respiratory Distress: As the epiglottis swells and obstructs the airway, individuals may exhibit signs of respiratory distress, such as high-pitched breathing sounds (stridor), rapid and labored breathing, retractions (pulling in of the chest wall), and cyanosis (bluish discoloration of the skin) due to inadequate oxygenation.
Fever: Elevated body temperature is common and may be accompanied by other signs of systemic inflammation.
Drooling: Difficulty swallowing can lead to excessive drooling, especially in children.
Croup (Laryngotracheobronchitis): Croup is a viral infection that causes upper airway inflammation, including the larynx and trachea. It typically affects children and presents with symptoms like epiglottitis, such as stridor, barking cough, and respiratory distress.
Retropharyngeal Abscess: This is a deep neck infection that can present with symptoms like epiglottitis. It involves the infection and abscess formation in the space behind the pharynx. Retropharyngeal abscess can cause difficulty swallowing, sore throat, fever, and respiratory distress.
Peritonsillar Abscess: Also known as quinsy, it is a localized collection of pus behind the tonsils. Peritonsillar abscess can cause severe throat pain, difficulty swallowing, and fever. Although the symptoms may overlap with epiglottitis, there is usually a visible asymmetrical swelling on examination, and the absence of significant respiratory distress helps distinguish it from epiglottitis.
Angioedema: Angioedema is swelling beneath the skin due to an allergic or non-allergic reaction. It can affect the airway and cause symptoms like epiglottitis, such as throat swelling, difficulty breathing, and stridor.
Foreign Body Aspiration: In children, aspiration of a foreign body into the airway can cause sudden airway obstruction and respiratory distress. This can present similarly to epiglottitis.
Acute Allergic Reaction: An acute severe allergic reaction, known as anaphylaxis, can cause rapid-onset airway swelling and compromise. It can present with symptoms resembling epiglottitis, including difficulty breathing, throat swelling, and stridor.
Croup (Laryngotracheobronchitis): Croup is a viral infection that causes upper airway inflammation, including the larynx and trachea. It typically affects children and presents with symptoms like epiglottitis, such as stridor, barking cough, and respiratory distress.
Retropharyngeal Abscess: This is a deep neck infection that can present with symptoms like epiglottitis. It involves the infection and abscess formation in the space behind the pharynx. Retropharyngeal abscess can cause difficulty swallowing, sore throat, fever, and respiratory distress.
Peritonsillar Abscess: Also known as quinsy, it is a localized collection of pus behind the tonsils. Peritonsillar abscess can cause severe throat pain, difficulty swallowing, and fever. Although the symptoms may overlap with epiglottitis, there is usually a visible asymmetrical swelling on examination, and the absence of significant respiratory distress helps distinguish it from epiglottitis.
Angioedema: Angioedema is swelling beneath the skin due to an allergic or non-allergic reaction. It can affect the airway and cause symptoms like epiglottitis, such as throat swelling, difficulty breathing, and stridor.
Foreign Body Aspiration: In children, aspiration of a foreign body into the airway can cause sudden airway obstruction and respiratory distress. This can present similarly to epiglottitis.
Acute Allergic Reaction: An acute severe allergic reaction, known as anaphylaxis, can cause rapid-onset airway swelling and compromise. It can present with symptoms resembling epiglottitis, including difficulty breathing, throat swelling, and stridor.
Pediatrics, General
Non-pharmacological approaches play a limited role in the immediate treatment of epiglottitis (supraglottitis), as this condition requires prompt medical intervention to secure the airway and administer appropriate antibiotics. The non-pharmacological approaches that can be considered are:
Airway Management Techniques: Non-pharmacological measures can help maintain a patent airway and facilitate breathing. These may include:
Positioning: Keeping the patient upright can help improve airway patency and reduce the risk of airway obstruction.
Humidification: Providing humidified air or supplemental oxygen can help soothe the airway and relieve symptoms of inflammation.
Nebulized Epinephrine: Nebulized epinephrine may be used in some cases to reduce airway swelling and alleviate respiratory distress.
Supportive Care: Non-pharmacological supportive measures can assist in the patient’s comfort and recovery. These may include:
Fluids and Nutrition: Adequate hydration and nutrition are essential for recovery. Intravenous fluids may be administered if swallowing is difficult or unsafe.
Rest and Comfort: Providing a calm and quiet environment can help reduce stress and promote healing. Rest and sleep are also crucial for recovery.
Monitoring: Regular monitoring of vital signs, including oxygen saturation and respiratory rate, ensures early detection of changes in the patient’s condition.
Psychological Support: Epiglottitis can be a frightening experience for patients, particularly children. Providing emotional support and reassurance can help alleviate anxiety and promote healing.
Emergency Medicine
The primary treatment for epiglottitis (supraglottitis) involves the administration of appropriate pharmaceutical agents, specifically antibiotics, to target the underlying bacterial infection. The choice of antibiotics is based on the likely causative pathogens and local antibiotic susceptibility patterns. The commonly used drugs for the treatment of epiglottitis are:
Third-generation Cephalosporins: Cephalosporins are the first-line antibiotics for epiglottitis due to their efficacy against the most common pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae. Third-generation cephalosporins, including cefotaxime and ceftriaxone, are frequently used due to their broad spectrum of activity and good tissue penetration.
Ampicillin/Sulbactam: This combination antibiotic may be an alternative to third-generation cephalosporins, particularly in patients with a history of beta-lactam allergy.
Piperacillin/Tazobactam: Another alternative antibiotic regimen, piperacillin/tazobactam, may be used in cases where a broader spectrum of activity is desired or if there is a concern for potential resistance.
Vancomycin is the anti staphylococcal agent of choice in patients with epiglottitis complicated by sepsis, those with concomitant meningitis, or those from areas with an increased prevalence of clindamycin-resistant methicillin-resistant S aureus
Emergency Medicine
The primary treatment for epiglottitis (supraglottitis) involves the administration of appropriate pharmaceutical agents, specifically antibiotics, to target the underlying bacterial infection. The choice of antibiotics is based on the likely causative pathogens and local antibiotic susceptibility patterns. The commonly used drugs for the treatment of epiglottitis are:
Third-generation Cephalosporins: Cephalosporins are the first-line antibiotics for epiglottitis due to their efficacy against the most common pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae. Third-generation cephalosporins, including cefotaxime and ceftriaxone, are frequently used due to their broad spectrum of activity and good tissue penetration.
Ampicillin/Sulbactam: This combination antibiotic may be an alternative to third-generation cephalosporins, particularly in patients with a history of beta-lactam allergy.
Piperacillin/Tazobactam: Another alternative antibiotic regimen, piperacillin/tazobactam, may be used in cases where a broader spectrum of activity is desired or if there is a concern for potential resistance.
Vancomycin is the anti staphylococcal agent of choice in patients with epiglottitis complicated by sepsis, those with concomitant meningitis, or those from areas with an increased prevalence of clindamycin-resistant methicillin-resistant S aureus
Emergency Medicine
Bronchodilators, commonly used in conditions such as asthma or chronic obstructive pulmonary disease (COPD), are not indicated in treating epiglottitis. The obstruction in epiglottitis occurs at the supraglottic level, involving the epiglottis and upper airway, rather than the lower airways targeted by bronchodilators.
Similarly, while glucocorticoids may have anti-inflammatory effects and are used in various respiratory conditions, their role in treating epiglottitis is limited. The primary treatment for epiglottitis involves antibiotics to target bacterial infection and reduce airway inflammation. Glucocorticoids are not routinely recommended as adjunctive therapy for epiglottitis, and their use remains controversial.
Dexamethasone: Dexamethasone is a potent corticosteroid with anti-inflammatory and immunosuppressive properties. dexamethasone helps reduce inflammation and swelling of the epiglottis, improving symptoms, and facilitating healing. It is typically administered intravenously (IV) or intramuscularly (IM) in the hospital setting. An initial bolus dose of 4 to 10 mg of dexamethasone is given, followed by a repeated IV dose of 4 mg every 6 hours. The dosage may vary depending on the severity of the condition and individual patient factors. Close observation of the airway is essential during treatment.
Budesonide Inhaled: budesonide is an inhaled corticosteroid primarily used to treat respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). However, in cases of epiglottitis, if the airway is secure and the inflammation is localized to the epiglottis, nebulized or inhaled budesonide may be considered an adjunctive treatment.
Emergency Medicine
Analgesics, precisely non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (paracetamol), can play a supportive role in the treatment of epiglottitis (supraglottitis). While these medications do not directly treat the underlying infection, they can help manage symptoms and improve patient comfort. Here’s the role of analgesics in the treatment of epiglottitis:
Pain Relief: Epiglottitis often presents with severe throat pain, which can cause significant discomfort for patients. Analgesics can help alleviate this pain and improve the individual’s overall well-being. Reduced pain can make swallowing and breathing less distressing, facilitating oral intake and maintaining hydration.
Fever Reduction: Epiglottitis is commonly associated with fever. NSAIDs and acetaminophen effectively reduce fever, which can relieve and help restore the patient’s normal body temperature. By reducing fever, analgesics may also contribute to improved comfort and overall well-being.
Anti-inflammatory Effects: NSAIDs, such as ibuprofen or naproxen, have anti-inflammatory properties. They can help reduce inflammation in the throat and surrounding tissues, easing swelling and improving symptoms. However, it’s important to note that the primary treatment for epiglottitis is antibiotic therapy to address the underlying bacterial infection, and analgesics should be used as adjunctive therapy.
Emergency Medicine
In cases of severe airway compromise or impending airway obstruction due to epiglottitis (supraglottis), various procedures may be performed to secure the airway and provide immediate relief. These interventions are typically performed by healthcare professionals experienced in airway management, such as emergency medicine physicians or otolaryngologists. Here are some procedures that can be used for the treatment of epiglottitis:
Endotracheal Intubation: Endotracheal intubation involves the insertion of a tube into the trachea through the mouth or nose to establish a secure airway. It is performed using a laryngoscope or with the assistance of video laryngoscopy. Endotracheal intubation allows for mechanical ventilation and ensures a patent airway.
Tracheostomy: It is a surgical procedure in which an incision is made in the neck, and a breathing tube (tracheostomy tube) is inserted directly into the trachea. This bypasses the upper airway obstruction caused by the inflamed epiglottis, providing a secure airway. Tracheostomy is typically reserved for severe airway compromise or failed endotracheal intubation.
Supraglottic Airway Devices: Supraglottic airway devices, such as the laryngeal mask airway (LMA), may be used as a temporary measure to establish a patent airway in cases where endotracheal intubation or tracheostomy is not immediately feasible or indicated. These devices sit above the vocal cords and provide a seal in the hypopharynx, allowing for ventilation and oxygenation.
Pediatrics, General
The management of epiglottitis typically involves several phases to ensure effective treatment and patient safety. These phases include:
Initial Assessment and Stabilization: The initial phase involves promptly assessing the patient’s airway, breathing, and circulation (ABC) to identify signs of airway compromise or respiratory distress. Airway management is a priority, and interventions such as providing supplemental oxygen and maintaining the patient upright may be initiated. In severe cases, immediate intubation or other airway interventions may be necessary to secure the airway and ensure adequate ventilation.
Diagnostic Evaluation: A comprehensive diagnostic evaluation is conducted once the patient’s airway is secured and stabilized. This evaluation includes a thorough history, physical examination, and appropriate diagnostic tests, such as blood tests and imaging studies (e.g., X-ray, CT scan). The purpose is to identify the underlying cause of epiglottitis, such as bacterial infection, and assess the severity and extent of the inflammation.
Antibiotic Therapy: Early initiation of antibiotic therapy is crucial in managing epiglottitis to target the underlying bacterial infection. Empiric antibiotic treatment is typically initiated based on the likely causative pathogens and local antibiotic susceptibility patterns. Third-generation cephalosporins, such as cefotaxime or ceftriaxone, are commonly used due to their broad spectrum of activity against common pathogens associated with epiglottitis.
Supportive Care and Symptom Management: Supportive care measures aim to alleviate symptoms and promote patient comfort during recovery. Analgesics, such as NSAIDs or acetaminophen, may be prescribed to relieve pain and reduce fever. Adequate hydration and maintaining a humidified environment can help alleviate discomfort and promote airway moisture.
Monitoring and Observation: Closely monitoring the patient’s vital signs, oxygen saturation, and respiratory status is essential. Continuous airway, breathing, and circulation assessment are performed to ensure adequate oxygenation and ventilation. Serial examinations and follow-up imaging may be conducted to monitor the resolution of inflammation and assess the patient’s progress.
Epiglottitis.ncbi.nlm.nih
The Changing Epidemiology:ncbi.nlm.nih
Epiglottitis in the Hemophilus.ncbi.nlm.nih
Croup.ncbi.nlm.nih
Medical Management of Epiglottitis.ncbi.nlm.nih
Epiglottitis, also known as supraglottitis is a severe condition characterized by the inflammation and swelling of the epiglottis, a flap of cartilage located at the base of the tongue, which helps prevent food and fluids from entering the windpipe (trachea) during swallowing. This condition can obstruct the airway and cause severe respiratory distress, making it a medical emergency.
Historically, epiglottitis was primarily caused by infection with Haemophilus influenzae type b (Hib) bacteria. However, with the introduction of Hib vaccination, the incidence of Hib-related epiglottitis has significantly declined. Non-typeable Haemophilus influenzae (NTHi), Streptococcus pneumoniae, and other bacterial or viral pathogens are more commonly associated with epiglottitis.
Epiglottitis has undergone significant changes in epidemiology, primarily due to the introduction of the Haemophilus influenzae type b (Hib) vaccine. Before widespread vaccination, Hib was the predominant cause of epiglottitis in children and adults. Here is an overview of the epidemiology of epiglottitis:
Pre-Hib Vaccine Era:Â
Incidence: Before introducing the Hib vaccine, the annual incidence of epiglottitis in children ranged from 1 to 8 cases per 100,000 children. The incidence was lower in adults, ranging from 0.5 to 1.8 cases per 100,000 adults.
Age Distribution: Epiglottitis primarily affects children between the ages of 2 and 6 years, with a peak incidence around 3-4 years. However, it could occur in individuals of any age, including adults.
Causative Pathogen: Hib was responsible for most cases, accounting for approximately 80-95% of pediatric epiglottitis and a significant proportion in adults.
Post-Hib Vaccine Era:
Impact of Hib Vaccine: The introduction of the Hib conjugate vaccine in the late 1980s and early 1990s dramatically reduced the incidence of Hib-related epiglottitis. Hib vaccine coverage has led to a decline of over 90% in Hib-associated invasive diseases, including epiglottitis.
Changing Pathogens: With the decrease in Hib-related cases, non-typeable Haemophilus influenzae (NTHi) has emerged as the leading cause of epiglottitis in the post-Hib vaccine era. Other bacterial pathogens, such as Streptococcus pneumoniae, Staphylococcus aureus, and group A Streptococcus, as well as viral causes, have also been implicated.
Infection or Inflammation Trigger: In the pre-vaccine era, Haemophilus influenzae type b (Hib) was the predominant causative bacterium. However, with the widespread use of the Hib vaccine, non-typeable Haemophilus influenzae (NTHi) and other bacterial or viral pathogens have become more common causes.
Inflammatory Response: The infectious agent or other inflammatory triggers initiate an immune response. In the case of infectious causes, the pathogen invades the tissues of the epiglottis, leading to an immune response aimed at eliminating the infection.
Edema and Swelling: Inflammatory mediators and immune cell activation cause increased permeability of blood vessels in the affected area. This results in fluid leakage into the tissues of the epiglottis, leading to edema (swelling).
Airway Obstruction: The epiglottis typically covers the opening of the larynx (voice box) during swallowing, preventing food and fluids from entering the airway. However, with significant edema and swelling, the enlarged epiglottis obstructs the airway, potentially leading to respiratory distress and compromised breathing.
Respiratory Distress: As the airway becomes progressively obstructed, individuals with epiglottitis may experience symptoms of respiratory distress due to inadequate oxygenation.
The specific etiology can vary depending on the individual’s age group and immunization status. Here are some critical etiological factors:
Haemophilus influenzae type b (Hib): Before introducing the Hib vaccine, Hib was the leading cause of epiglottitis, particularly in children. However, with widespread vaccination, the incidence of Hib-related cases has significantly decreased.
Non-Typeable Haemophilus influenzae (NTHi): NTHi has emerged as the most common bacterial cause of epiglottitis, affecting children and adults.
Streptococcus pneumoniae: Pneumococcal bacteria can occasionally cause epiglottitis, especially in older children and adults.
Other Bacterial Pathogens: Rarely, other bacteria like Staphylococcus aureus or group A Streptococcus (Streptococcus pyogenes) can be associated with epiglottitis.
Viral pathogens, such as influenza viruses, parainfluenza viruses, adenoviruses, and respiratory syncytial virus (RSV), can cause inflammation and swelling of the epiglottis, leading to epiglottitis in some cases. Viral-induced epiglottitis is more common in children.
Thermal Burns: In rare instances, thermal burns from hot liquids or corrosive substances can cause severe inflammation and swelling of the epiglottis, leading to epiglottitis.
Allergic Reactions: In rare cases, severe allergic reactions (anaphylaxis) can cause swelling of the epiglottis, resulting in a clinical presentation like infectious epiglottitis.
Age: Younger children, particularly those under 5, are historically at higher risk of severe complications and poorer outcomes. This is partly due to the relatively smaller size of their airways, which can lead to more rapid and severe airway obstruction in the presence of epiglottitis.
Vaccination Status: The widespread use of the Haemophilus influenzae type b (Hib) vaccine has significantly impacted the prognosis of epiglottitis. Hib vaccination has dramatically reduced the incidence of Hib-related epiglottitis and its associated complications.
Timely Medical Intervention: Immediate medical attention, including securing the airway if necessary, administering appropriate antibiotics, and providing supportive care, can significantly improve the prognosis.
Presence of Complications: Some individuals with epiglottitis may develop complications, such as respiratory failure, sepsis, or pneumonia.
Pathogen Type: The pathogen causing epiglottitis can influence the severity and prognosis. While non-typeable Haemophilus influenzae (NTHi) is the most common cause of epiglottitis in the post-Hib vaccine era, other bacteria or viral pathogens can also contribute.
Coexisting Medical Conditions: The presence of underlying medical conditions or comorbidities, such as immunodeficiency disorders or chronic respiratory conditions, can increase the risk of complications and affect the prognosis.
Timeliness of Antibiotic Treatment: Appropriate antibiotic therapy is crucial in managing epiglottitis of bacterial origin. Timely initiating appropriate antibiotics targeting the causative pathogen can help control the infection, reduce inflammation, and improve the prognosis.
Age Group: Epiglottitis can occur in individuals of any age, but there are variations in its clinical presentation based on age.
Children: Epiglottitis is more commonly seen in children, with a peak incidence between 2 and 6 years of age.
Adults: The presentation may be less severe in adults and have a more gradual onset than in children.
Associated Comorbidity or Activity: Certain factors may be associated with an increased risk of developing epiglottitis or influencing its severity. These include:
Immunization Status: Individuals who have not received the Haemophilus influenzae type b (Hib) vaccine or have incomplete immunization may be at higher risk, especially in children.
Smoking: Smoking can increase the risk and severity of epiglottitis.
Comorbidities: Underlying conditions, such as immunodeficiency disorders or chronic respiratory conditions, may predispose individuals to develop more severe forms of epiglottitis.
General Appearance: Evaluate the patient’s overall appearance and behavior. Patients with epiglottitis may appear anxious, distressed, or in respiratory distress.
Vital Signs: Measure vital signs, including heart rate, respiratory rate, blood pressure, and oxygen saturation. Tachycardia (rapid heart rate) and tachypnea (rapid breathing) may be present.
Respiratory Assessment:
Observe for signs of respiratory distress, such as increased work of breathing, use of accessory muscles, nasal flaring, and intercostal retractions.
Listen for abnormal breathing sounds, including stridor (high-pitched inspiratory noise) and decreased breath sounds, indicating airway obstruction.
Neck Examination:Â
Inspection: Observe the neck for any visible swelling or fullness.
Palpation: Gentle palpation of the neck may reveal tenderness or swelling.
Oral Cavity and Throat Examination: Inspect the oral cavity for signs of inflammation, such as redness, swelling, or exudate on the tonsils or pharynx. Note any drooling, which can indicate difficulty swallowing.
Avoid Stimulating the Epiglottis: Avoid any actions that may cause stimulation of the epiglottis, such as throat swabs or attempts to visualize the epiglottis directly. These actions may trigger spasms or worsen airway obstruction.
The acuity of the presentation can vary, but typically the onset of symptoms is sudden and progresses rapidly.
Severe Sore Throat: Individuals with epiglottitis often experience severe throat pain.
Dysphagia: Difficulty swallowing and a refusal to eat or drink are common due to the obstructed airway.
Respiratory Distress: As the epiglottis swells and obstructs the airway, individuals may exhibit signs of respiratory distress, such as high-pitched breathing sounds (stridor), rapid and labored breathing, retractions (pulling in of the chest wall), and cyanosis (bluish discoloration of the skin) due to inadequate oxygenation.
Fever: Elevated body temperature is common and may be accompanied by other signs of systemic inflammation.
Drooling: Difficulty swallowing can lead to excessive drooling, especially in children.
Croup (Laryngotracheobronchitis): Croup is a viral infection that causes upper airway inflammation, including the larynx and trachea. It typically affects children and presents with symptoms like epiglottitis, such as stridor, barking cough, and respiratory distress.
Retropharyngeal Abscess: This is a deep neck infection that can present with symptoms like epiglottitis. It involves the infection and abscess formation in the space behind the pharynx. Retropharyngeal abscess can cause difficulty swallowing, sore throat, fever, and respiratory distress.
Peritonsillar Abscess: Also known as quinsy, it is a localized collection of pus behind the tonsils. Peritonsillar abscess can cause severe throat pain, difficulty swallowing, and fever. Although the symptoms may overlap with epiglottitis, there is usually a visible asymmetrical swelling on examination, and the absence of significant respiratory distress helps distinguish it from epiglottitis.
Angioedema: Angioedema is swelling beneath the skin due to an allergic or non-allergic reaction. It can affect the airway and cause symptoms like epiglottitis, such as throat swelling, difficulty breathing, and stridor.
Foreign Body Aspiration: In children, aspiration of a foreign body into the airway can cause sudden airway obstruction and respiratory distress. This can present similarly to epiglottitis.
Acute Allergic Reaction: An acute severe allergic reaction, known as anaphylaxis, can cause rapid-onset airway swelling and compromise. It can present with symptoms resembling epiglottitis, including difficulty breathing, throat swelling, and stridor.
Croup (Laryngotracheobronchitis): Croup is a viral infection that causes upper airway inflammation, including the larynx and trachea. It typically affects children and presents with symptoms like epiglottitis, such as stridor, barking cough, and respiratory distress.
Retropharyngeal Abscess: This is a deep neck infection that can present with symptoms like epiglottitis. It involves the infection and abscess formation in the space behind the pharynx. Retropharyngeal abscess can cause difficulty swallowing, sore throat, fever, and respiratory distress.
Peritonsillar Abscess: Also known as quinsy, it is a localized collection of pus behind the tonsils. Peritonsillar abscess can cause severe throat pain, difficulty swallowing, and fever. Although the symptoms may overlap with epiglottitis, there is usually a visible asymmetrical swelling on examination, and the absence of significant respiratory distress helps distinguish it from epiglottitis.
Angioedema: Angioedema is swelling beneath the skin due to an allergic or non-allergic reaction. It can affect the airway and cause symptoms like epiglottitis, such as throat swelling, difficulty breathing, and stridor.
Foreign Body Aspiration: In children, aspiration of a foreign body into the airway can cause sudden airway obstruction and respiratory distress. This can present similarly to epiglottitis.
Acute Allergic Reaction: An acute severe allergic reaction, known as anaphylaxis, can cause rapid-onset airway swelling and compromise. It can present with symptoms resembling epiglottitis, including difficulty breathing, throat swelling, and stridor.
Pediatrics, General
Non-pharmacological approaches play a limited role in the immediate treatment of epiglottitis (supraglottitis), as this condition requires prompt medical intervention to secure the airway and administer appropriate antibiotics. The non-pharmacological approaches that can be considered are:
Airway Management Techniques: Non-pharmacological measures can help maintain a patent airway and facilitate breathing. These may include:
Positioning: Keeping the patient upright can help improve airway patency and reduce the risk of airway obstruction.
Humidification: Providing humidified air or supplemental oxygen can help soothe the airway and relieve symptoms of inflammation.
Nebulized Epinephrine: Nebulized epinephrine may be used in some cases to reduce airway swelling and alleviate respiratory distress.
Supportive Care: Non-pharmacological supportive measures can assist in the patient’s comfort and recovery. These may include:
Fluids and Nutrition: Adequate hydration and nutrition are essential for recovery. Intravenous fluids may be administered if swallowing is difficult or unsafe.
Rest and Comfort: Providing a calm and quiet environment can help reduce stress and promote healing. Rest and sleep are also crucial for recovery.
Monitoring: Regular monitoring of vital signs, including oxygen saturation and respiratory rate, ensures early detection of changes in the patient’s condition.
Psychological Support: Epiglottitis can be a frightening experience for patients, particularly children. Providing emotional support and reassurance can help alleviate anxiety and promote healing.
Emergency Medicine
The primary treatment for epiglottitis (supraglottitis) involves the administration of appropriate pharmaceutical agents, specifically antibiotics, to target the underlying bacterial infection. The choice of antibiotics is based on the likely causative pathogens and local antibiotic susceptibility patterns. The commonly used drugs for the treatment of epiglottitis are:
Third-generation Cephalosporins: Cephalosporins are the first-line antibiotics for epiglottitis due to their efficacy against the most common pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae. Third-generation cephalosporins, including cefotaxime and ceftriaxone, are frequently used due to their broad spectrum of activity and good tissue penetration.
Ampicillin/Sulbactam: This combination antibiotic may be an alternative to third-generation cephalosporins, particularly in patients with a history of beta-lactam allergy.
Piperacillin/Tazobactam: Another alternative antibiotic regimen, piperacillin/tazobactam, may be used in cases where a broader spectrum of activity is desired or if there is a concern for potential resistance.
Vancomycin is the anti staphylococcal agent of choice in patients with epiglottitis complicated by sepsis, those with concomitant meningitis, or those from areas with an increased prevalence of clindamycin-resistant methicillin-resistant S aureus
Emergency Medicine
The primary treatment for epiglottitis (supraglottitis) involves the administration of appropriate pharmaceutical agents, specifically antibiotics, to target the underlying bacterial infection. The choice of antibiotics is based on the likely causative pathogens and local antibiotic susceptibility patterns. The commonly used drugs for the treatment of epiglottitis are:
Third-generation Cephalosporins: Cephalosporins are the first-line antibiotics for epiglottitis due to their efficacy against the most common pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae. Third-generation cephalosporins, including cefotaxime and ceftriaxone, are frequently used due to their broad spectrum of activity and good tissue penetration.
Ampicillin/Sulbactam: This combination antibiotic may be an alternative to third-generation cephalosporins, particularly in patients with a history of beta-lactam allergy.
Piperacillin/Tazobactam: Another alternative antibiotic regimen, piperacillin/tazobactam, may be used in cases where a broader spectrum of activity is desired or if there is a concern for potential resistance.
Vancomycin is the anti staphylococcal agent of choice in patients with epiglottitis complicated by sepsis, those with concomitant meningitis, or those from areas with an increased prevalence of clindamycin-resistant methicillin-resistant S aureus
Emergency Medicine
Bronchodilators, commonly used in conditions such as asthma or chronic obstructive pulmonary disease (COPD), are not indicated in treating epiglottitis. The obstruction in epiglottitis occurs at the supraglottic level, involving the epiglottis and upper airway, rather than the lower airways targeted by bronchodilators.
Similarly, while glucocorticoids may have anti-inflammatory effects and are used in various respiratory conditions, their role in treating epiglottitis is limited. The primary treatment for epiglottitis involves antibiotics to target bacterial infection and reduce airway inflammation. Glucocorticoids are not routinely recommended as adjunctive therapy for epiglottitis, and their use remains controversial.
Dexamethasone: Dexamethasone is a potent corticosteroid with anti-inflammatory and immunosuppressive properties. dexamethasone helps reduce inflammation and swelling of the epiglottis, improving symptoms, and facilitating healing. It is typically administered intravenously (IV) or intramuscularly (IM) in the hospital setting. An initial bolus dose of 4 to 10 mg of dexamethasone is given, followed by a repeated IV dose of 4 mg every 6 hours. The dosage may vary depending on the severity of the condition and individual patient factors. Close observation of the airway is essential during treatment.
Budesonide Inhaled: budesonide is an inhaled corticosteroid primarily used to treat respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). However, in cases of epiglottitis, if the airway is secure and the inflammation is localized to the epiglottis, nebulized or inhaled budesonide may be considered an adjunctive treatment.
Emergency Medicine
Analgesics, precisely non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (paracetamol), can play a supportive role in the treatment of epiglottitis (supraglottitis). While these medications do not directly treat the underlying infection, they can help manage symptoms and improve patient comfort. Here’s the role of analgesics in the treatment of epiglottitis:
Pain Relief: Epiglottitis often presents with severe throat pain, which can cause significant discomfort for patients. Analgesics can help alleviate this pain and improve the individual’s overall well-being. Reduced pain can make swallowing and breathing less distressing, facilitating oral intake and maintaining hydration.
Fever Reduction: Epiglottitis is commonly associated with fever. NSAIDs and acetaminophen effectively reduce fever, which can relieve and help restore the patient’s normal body temperature. By reducing fever, analgesics may also contribute to improved comfort and overall well-being.
Anti-inflammatory Effects: NSAIDs, such as ibuprofen or naproxen, have anti-inflammatory properties. They can help reduce inflammation in the throat and surrounding tissues, easing swelling and improving symptoms. However, it’s important to note that the primary treatment for epiglottitis is antibiotic therapy to address the underlying bacterial infection, and analgesics should be used as adjunctive therapy.
Emergency Medicine
In cases of severe airway compromise or impending airway obstruction due to epiglottitis (supraglottis), various procedures may be performed to secure the airway and provide immediate relief. These interventions are typically performed by healthcare professionals experienced in airway management, such as emergency medicine physicians or otolaryngologists. Here are some procedures that can be used for the treatment of epiglottitis:
Endotracheal Intubation: Endotracheal intubation involves the insertion of a tube into the trachea through the mouth or nose to establish a secure airway. It is performed using a laryngoscope or with the assistance of video laryngoscopy. Endotracheal intubation allows for mechanical ventilation and ensures a patent airway.
Tracheostomy: It is a surgical procedure in which an incision is made in the neck, and a breathing tube (tracheostomy tube) is inserted directly into the trachea. This bypasses the upper airway obstruction caused by the inflamed epiglottis, providing a secure airway. Tracheostomy is typically reserved for severe airway compromise or failed endotracheal intubation.
Supraglottic Airway Devices: Supraglottic airway devices, such as the laryngeal mask airway (LMA), may be used as a temporary measure to establish a patent airway in cases where endotracheal intubation or tracheostomy is not immediately feasible or indicated. These devices sit above the vocal cords and provide a seal in the hypopharynx, allowing for ventilation and oxygenation.
Pediatrics, General
The management of epiglottitis typically involves several phases to ensure effective treatment and patient safety. These phases include:
Initial Assessment and Stabilization: The initial phase involves promptly assessing the patient’s airway, breathing, and circulation (ABC) to identify signs of airway compromise or respiratory distress. Airway management is a priority, and interventions such as providing supplemental oxygen and maintaining the patient upright may be initiated. In severe cases, immediate intubation or other airway interventions may be necessary to secure the airway and ensure adequate ventilation.
Diagnostic Evaluation: A comprehensive diagnostic evaluation is conducted once the patient’s airway is secured and stabilized. This evaluation includes a thorough history, physical examination, and appropriate diagnostic tests, such as blood tests and imaging studies (e.g., X-ray, CT scan). The purpose is to identify the underlying cause of epiglottitis, such as bacterial infection, and assess the severity and extent of the inflammation.
Antibiotic Therapy: Early initiation of antibiotic therapy is crucial in managing epiglottitis to target the underlying bacterial infection. Empiric antibiotic treatment is typically initiated based on the likely causative pathogens and local antibiotic susceptibility patterns. Third-generation cephalosporins, such as cefotaxime or ceftriaxone, are commonly used due to their broad spectrum of activity against common pathogens associated with epiglottitis.
Supportive Care and Symptom Management: Supportive care measures aim to alleviate symptoms and promote patient comfort during recovery. Analgesics, such as NSAIDs or acetaminophen, may be prescribed to relieve pain and reduce fever. Adequate hydration and maintaining a humidified environment can help alleviate discomfort and promote airway moisture.
Monitoring and Observation: Closely monitoring the patient’s vital signs, oxygen saturation, and respiratory status is essential. Continuous airway, breathing, and circulation assessment are performed to ensure adequate oxygenation and ventilation. Serial examinations and follow-up imaging may be conducted to monitor the resolution of inflammation and assess the patient’s progress.
Epiglottitis.ncbi.nlm.nih
The Changing Epidemiology:ncbi.nlm.nih
Epiglottitis in the Hemophilus.ncbi.nlm.nih
Croup.ncbi.nlm.nih
Medical Management of Epiglottitis.ncbi.nlm.nih
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