[6] Epiglottitis Flashcards
What is acute epiglottitis?
Inflammation of the epiglottis mostly due to infection but can have other causes
Why epiglottitis important?
It is potentially life threatening if complete obstruction of the airway occurs
What is the most common causative organism of epiglottitis?
Streptococcus spp
What was previously the most common cause of epiglottitis?
Haemophilus influenza type B
Why is Hib not the most common cause of epiglottitis any more?
Introduction of vaccination
What are some other bacterial causes of epiglottitis?
- Staph. Aureus
- Pseudomonas
- Moraxella catarrhalis
- Mycobacterium TB
What is a viral cause of epiglottitis?
- Herpes simplex
What can cause epiglottitis in immunocompromised patients?
- Candida
- Aspergillus
What are some non-infectious causes of epiglottitis?
- Thermal causes
- Caustic insults
- Foreign bodies
- Trauma
What thermal causes can cause epiglottitis?
- Steam
- Crack cocaine smoking
What can cause caustic epiglottitis?
Dishwasher pellets
What are the risk factors for epiglottitis?
- Non-vaccinated with Hib vaccine
- Immunocompromised
- Middle aged
What are the most common symptoms of epiglottitis?
- Sore throat
- Odynophagia
- Inability to swallow secretions (drooling in children)
- Muffled voice (‘hot potato’ voice)
- Fever
What are other features of epiglottitis?
- High temperature
- Tachycardia
- Anterior neck tenderness over hyoid bone
- Ear pain
- Cervical lymphadenopathy
What are some features of severe epiglottitis?
- Dyspnoea
- Dysphagia
- Dysphonia
- Respiratory distress
- Stridor
What is stridor a sign of in epiglottitis?
Upper airway obstruction and is a surgical emergency
Why can diagnosis of epiglottitis be difficult in adults?
They may not have signs of respiratory distress
If a patient has persistent and significant sore throat what should happen?
Referral to ENT for direct visualisation by flexible laryngoscopy
What is the gold standard investigation for epiglottitis?
Fibre-optic laryngoscopy
If laryngoscopy is not possible what else can help to identify epiglottitis?
Lateral neck x-ray
What test should be performed in epiglottitis if the airway is secure or intubation/tracheostomy is available?
Throat swabs
If the patient with epiglottitis is systemically unwell what additional test should be performed?
Blood cultures
If abscess formation due to epiglottitis is suspected what investigations should be performed?
CT or MRI
What are the differentials for epiglottitis?
- Pharyngitis
- Laryngitis
- Inhaled foreign body
- Croup
- Retropharyngeal abscess
What is the usual management of epiglottitis?
Conservative with IV or oral antibiotics
What interventions may be needed in patients with severe airway obstruction?
- Intubation
- Surgical tracheostomy if intubation not possible
What are the potential complications of epiglottitis?
- Abscess formation
- Meningitis
- Sepsis
- Pneumothorax
