Epiglottitis

Epiglottitis is a life-threatening condition caused by inflammation of the epiglottis and aryepiglottic folds 1,  which can lead to acute airway obstruction. Treatment should be urgent and performed by appropriately trained individuals, e.g. instrumentation of the trachea should be performed by a senior or a trained anesthesiologist.

The traditional age of presentation is in children of 3 to 6 years, although this has been changing due to the routine vaccination against Haemophilus influenzae type B (Hib) introduced in most countries.

Hib used to be the most common responsible organism but group A beta-hemolytic Streptococci is becoming more common due to Hib vaccinations 4.

The presentation has a very rapid course beginning with a sore throat and leading to difficulty swallowing and drooling. However, other presenting symptoms include:

  • fever
  • difficulty speaking
  • muffling or changes in the voice
  • inspiratory stridor
  • severe dysphagia

Lateral soft tissue radiograph of the neck demonstrates thickening of the epiglottis and aryepiglottic folds referred to as the thumb sign.

It should be noted that an omega epiglottis, either a variant of normal or in the setting of laryngomalacia, can result in a similar appearance and can be mistaken for epiglottitis. 

In epiglottitis, the hypopharynx may be over-distended.

CT is only rarely obtained, and usually when the diagnosis is unclear. Indeed, placing the child in the supine position can actually precipitate respiratory arrest. If a scan is obtained, marked edema and thickening of the epiglottis and aryepiglottic folds may be seen with narrowing of the airway.

Treatment must be expeditious given the life-threatening nature of the condition:

  • patients should be kept upright in a comfortable position
  • airway management with oxygen therapy
  • early tracheal intubation by specialist staff: if ET tube placement is impossible because of an inflamed epiglottis, emergency needle cricotracheostomy may need to be performed
  • IV fluids
  • IV steroids and antibiotics
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Article information

rID: 8408
Synonyms or Alternate Spellings:
  • Inflammation of the epiglottis

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Cases and figures

  • Figure 1: normal location
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  •  Case 2: with thumb sign
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  • Epiglottitis 1
    Case 1: overdistended hypopharynx
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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