Epiglottitis

Question 1

What is epiglottitis?

Answer 1

Epiglottitis is acute inflammation of the epiglottis, which can rapidly progress to severe airway obstruction, usually associated with significant systemic illness.

Question 2

anatomically, where is the epiglottis?

Answer 2

The epiglottis is a cartilaginous flap located in the larynx

Question 3

What is the epiglottitis’’ function?

Answer 3

Its function is to close over the opening to the airway (glottis) during swallowing. This prevents food or liquids from passing into the trachea and the lungs.

Question 4

What can inflammation of the epiglottis lead to?

Answer 4

Airway obstruction

Question 5

What is the most common cause of epiglottitis?

Answer 5

Infection

Question 6

What pathogen is the most common cause for epiglottitis?

Answer 6

Haemophilus influenzae type b (Hib)

Question 7

What has reduce the incidence of epiglottitis?

Answer 7

Hib Vaccine

Question 8

What other organisms can cause epiglottitis?

Answer 8

streptococcus pneumoniae, group A streptococci and staphylococcus aureus

Question 9

Can virus’ cause epiglottitis?

Answer 9

Yes but is rare

Question 10

What are 3 examples of viral causes of epiglottitis?

Answer 10

1. Herpes simplex virus
2. Infectious mononucleosis
3. Fungal infections like candida

Question 11

What are some non-infectious causes?

Answer 11

1. Thermal injuries
2. Chemical burns
3. Foreign body ingestion

Question 12

What are 4 risk factors for epiglottitis?

Answer 12

1. Individuals without the Hib vaccine
2. Immunocompromised patients
3. Men in mid-40s
   Additional co-morbidities

Question 13

What are typical symptoms of epiglottitis?

Answer 13

Severe and acute onset of sore throat
Muffled voice
Drooling
Inspiratory stridor
Difficulty swallowing (dysphagia) and/or painful swallowing (odynophagia)

Question 14

What do most patients also report alongside epiglottitis?

Answer 14

A recent upper respiratory tract infection (URTI)

Question 15

Do adults or children often present with a slower less severe set of symptoms?

Answer 15

Adults

Question 16

During clinical examination, why should no action be taken to stimulate or irritate the patient?

Answer 16

Because it may trigger a laryngospasm in an already critical airway.

Question 17

What can the symptom of a muffled voice often be referred to as?

Answer 17

Hot potato voice

Question 18

What position is common amongst patients with epiglottitis?

Answer 18

Tripod position: sitting up on hands, with the mouth open and head forward to increase airflow (commonly seen in children)

Question 19

What other clinical findings are typically present?

Answer 19

Drooling (more common in children)

Signs of respiratory distress: dyspnoea, tachypnoea, use of accessory muscles and cyanosis are severe findings and indicate impending respiratory failure (seen in both children and adults)

Inspiratory stridor: can sometimes be a late finding and indicates advanced upper airway obstruction.

Hypoxia

Tachycardia

Fever

Question 20

What are some differential diagnoses’ of a sore throat?

Answer 20

1. Acute tonsilitis
2. Acute pharyngitis
3. Peri-tonsillar abscess (Quinsy)
4. Deep neck space infection

Question 21

What are some differential diagnoses’ of stridor?

Answer 21

1. Laryngotracheobronchitis (Croup)
2. Foreign body inhalation
3. Anaphylaxis
4. Laryngitis

Question 22

Why are investigations in the immediate period avoided unless the patient is stable?

Answer 22

The condition is time critical

Question 23

What are the investigations if there is a strong clinical suspicion of epiglottitis in an unstable patient?

Answer 23

they will likely be taken to a controlled environment, such as the operating theatre, for examination of the airway plus endotracheal intubation or a surgical airway.

Question 24

Once the airway is secure, what other further laboratory investigations can be carried out?

Answer 24

1. Blood tests
2. Blood cultures
3. Culture swab from epiglottis

Question 25

What are the first-line investigations in a stable patient?

Answer 25

direct flexible (or rigid) laryngoscopy to visualise the airway. Normally performed by ENT, this confirms swelling and inflammation of the epiglottis and inflammation of surrounding supraglottic structures.

Question 26

What is used to secure the airway during investigations?

Answer 26

endotracheal intubation or an emergency surgical airway (i.e. tracheostomy)

Question 27

What is the second-line imaging for epiglottitis?

Answer 27

lateral neck radiograph

Question 28

What is referred to as the 'thumbprint sign' found on a lateral neck radiograph?

Answer 28

severely swollen epiglottis

Question 29

What is the main priority in management of epiglottitis?

Answer 29

The main priority is to secure the airway in a controlled environment, as patients (particularly children) can deteriorate quickly.

Question 30

What is the treatment of epiglottitis?

Answer 30

they will be managed in critical care with monitoring, IV antibiotics and subsequent extubation in a controlled setting.

Question 31

What does additional management include?

Answer 31

1. Nebulised adrenaline 2. High-flow oxygen 3. Intravenous broad-spectrum antibiotics 4. Corticosteroids 5. Fluid replacement therapy 6. Analgesia

Question 32

What intravenous broad-spectrum antibiotics are used to treat epiglottitis?

Answer 32

a third-generation cephalosporin (e.g. ceftriaxone or cefuroxime) is often used

Question 33

Why are corticosteroids used as treatment?

Answer 33

e.g., dexamethasone): usually given as a stat dose on acute presentation. corticosteroids may help reduce supraglottic inflammation.

Question 34

What are 3 complications of epiglottitis?

Answer 34

1. Epiglottitis abscess 2. Deep neck space infections 3. Mediastinitis

Question 35

Why is epiglottitis an emergency condition?

Answer 35

Epiglottitis represents a life-threatening condition which can quickly lead to severe airway obstruction with high mortality.