[6] Epiglottitis

Question 1

What is acute epiglottitis?

Answer 1

Inflammation of the epiglottis mostly due to infection but can have other causes

Question 2

Why epiglottitis important?

Answer 2

It is potentially life threatening if complete obstruction of the airway occurs

Question 3

What is the most common causative organism of epiglottitis?

Answer 3

Streptococcus spp

Question 4

What was previously the most common cause of epiglottitis?

Answer 4

Haemophilus influenza type B

Question 5

Why is Hib not the most common cause of epiglottitis any more?

Answer 5

Introduction of vaccination

Question 6

What are some other bacterial causes of epiglottitis?

Answer 6

• Staph. Aureus
• Pseudomonas
• Moraxella catarrhalis
• Mycobacterium TB

Question 7

What is a viral cause of epiglottitis?

Answer 7

• Herpes simplex

Question 8

What can cause epiglottitis in immunocompromised patients?

Answer 8

• Candida

- Aspergillus

Question 9

What are some non-infectious causes of epiglottitis?

Answer 9

• Thermal causes
• Caustic insults
• Foreign bodies
• Trauma

Question 10

What thermal causes can cause epiglottitis?

Answer 10

• Steam

- Crack cocaine smoking

Question 11

What can cause caustic epiglottitis?

Answer 11

Dishwasher pellets

Question 12

What are the risk factors for epiglottitis?

Answer 12

• Non-vaccinated with Hib vaccine
• Immunocompromised
• Middle aged

Question 13

What are the most common symptoms of epiglottitis?

Answer 13

• Sore throat
• Odynophagia
• Inability to swallow secretions (drooling in children)
• Muffled voice (‘hot potato’ voice)
• Fever

Question 14

What are other features of epiglottitis?

Answer 14

• High temperature
• Tachycardia
• Anterior neck tenderness over hyoid bone
• Ear pain
• Cervical lymphadenopathy

Question 15

What are some features of severe epiglottitis?

Answer 15

• Dyspnoea
• Dysphagia
• Dysphonia
• Respiratory distress
• Stridor

Question 16

What is stridor a sign of in epiglottitis?

Answer 16

Upper airway obstruction and is a surgical emergency

Question 17

Why can diagnosis of epiglottitis be difficult in adults?

Answer 17

They may not have signs of respiratory distress

Question 18

If a patient has persistent and significant sore throat what should happen?

Answer 18

Referral to ENT for direct visualisation by flexible laryngoscopy

Question 19

What is the gold standard investigation for epiglottitis?

Answer 19

Fibre-optic laryngoscopy

Question 20

If laryngoscopy is not possible what else can help to identify epiglottitis?

Answer 20

Lateral neck x-ray

Question 21

What test should be performed in epiglottitis if the airway is secure or intubation/tracheostomy is available?

Answer 21

Throat swabs

Question 22

If the patient with epiglottitis is systemically unwell what additional test should be performed?

Answer 22

Blood cultures

Question 23

If abscess formation due to epiglottitis is suspected what investigations should be performed?

Answer 23

CT or MRI

Question 24

What are the differentials for epiglottitis?

Answer 24

• Pharyngitis
• Laryngitis
• Inhaled foreign body
• Croup
• Retropharyngeal abscess

Question 25

What is the usual management of epiglottitis?

Answer 25

Conservative with IV or oral antibiotics

Question 26

What interventions may be needed in patients with severe airway obstruction?

Answer 26

• Intubation

- Surgical tracheostomy if intubation not possible

Question 27

What are the potential complications of epiglottitis?

Answer 27

• Abscess formation
• Meningitis
• Sepsis
• Pneumothorax