Epiglottitis
Epiglottitis is a rapidly progressive supraglottic infection that can obstruct the airway within hours; the exam is limited to inspection only, and airway control precedes any diagnostic confirmation in an unstable patient.
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What this article covers
- Overview
Life-threatening supraglottic infection: epiglottitis is a rapidly progressive inflammatory infection of the epiglottis and aryepiglottic folds that can cause partial or complete airway obstruction…
- Epidemiology
Epidemiology has shifted from children to adults: before universal Haemophilus influenzae type b (Hib) conjugate vaccination, Hib was the primary pathogen and epiglottitis was predominantly a…
- Risk factors
Incomplete or absent Hib immunization: the single strongest risk factor in children; look for an unvaccinated or under-vaccinated child.
- Pathophysiology
Direct bacterial or viral invasion of the supraglottic mucosa: the causative organism infects the epiglottis and aryepiglottic folds, triggering acute inflammation in the loosely attached, highly…
- Clinical features
Acute-onset high fever with severe sore throat: patients present with sudden-onset high fever (39 to 40 degrees C, 102 to 104 degrees F), severe odynophagia, and dysphagia, often evolving over hours rather than days.
- Differential diagnosis
Croup (laryngotracheobronchitis): slower onset than epiglottitis, barking cough, hoarseness, and a low-grade fever, without drooling or tripod positioning; usually affects children 3 months to 3…
- Diagnosis
A clinical diagnosis, confirmed by direct visualization once the airway is safe: epiglottitis is diagnosed by clinical impression (drooling, dysphagia, and respiratory distress with tripod…
- Management
First, secure the airway before confirming the diagnosis in any unstable or rapidly deteriorating patient: transfer immediately to the hospital or operating room and consult otolaryngology and…
- Complications
Complete airway obstruction and respiratory arrest: the most feared and immediately life-threatening complication, which is why airway management takes priority over every other step.
- Prognosis
Favorable with prompt airway management and antibiotics: most patients recover well and rarely require intubation or tracheostomy once the airway is secured and antibiotics are started.
- Prevention
Hib conjugate vaccination in the routine childhood immunization schedule: the single most effective preventive measure; widespread Hib vaccine use has reduced the incidence of invasive H.
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