Epiglottitis

Question 1

The epiglottis is a soft flap of tissue that sits beneath the tongue at the back of the throat. When we swallow this closes the airway so we do not aspirate food or drink into the lungs. Epiglottitis is when the epiglottis becomes inflamed. Is epiglottitis dangerous?

Answer 1

• yes

This is a life-threatening medical emergency characterised by inflammation of the epiglottis and surrounding supraglottic structures.

Causes rapid airway obstruction

Question 2

The epiglottis is anchored to the base of the tongue and what?

1 - vocal cords
2 - trachea
3 - anterior rim of the thyroid cartilage
4 - oesophagus

Answer 2

3 - anterior rim of the thyroid cartilage

Epiglottitis causes inflammation and enlarged epiglottis and surrounding tissues, including supraglottic structures

Question 3

Is epiglottitis more commonly seen in adults or infants?

Answer 3

• infants

Can affect any age, but most common in 2-7 y/o

Question 4

What is the incidence of epiglottitis?

1 - 2 per 100,000
2 - 200 per 100,000
3 - 2000 per 100,000
4 - 20,000 per 100,000

Answer 4

1 - 2 per 100,000

Affects males and females equally

Rare in the UK due to vaccination

Question 5

Which of the following is the most common cause of epiglottitis?

1 - foreign body
2 - iatrogenic
3 - bacterial infection
4 - viral infection

Answer 5

3 - bacterial infection

Viral and fungal infections, as well as non-infectious causes like thermal injury, can also contribute to the development of acute epiglottitis.

Question 6

Bacterial infection is the most common cause of epiglottitis. All of the following bacteria can cause epiglottitis, but which is the most common cause?

1 - Haemophilus influenzae type B
2 - Streptococcus pneumoniae
3 - Group A Streptococci
4 - Staphylococcus aureus

Answer 6

1 - Haemophilus influenzae type B

Question 7

Vaccination has reduced the incidence of epiglottitis. Which vaccine is responsible for this?

1 - Men B vaccine
2 - PCV vaccine
3 - Rotovirus vaccine
4 - Hib vaccine

Answer 7

4 - Hib vaccine

Hib = Haemophilus influenzae type B vaccine

Question 8

The symptoms of epiglottitis can vary, but typically is the presentation of symptoms insidious in onset or a rapid onset?

Answer 8

• rapid onset

Question 9

All of the following are symptoms of epiglottitis, except which one?

1 - severe sore throat
2 - odynophagia (painful swallowing
3 - reduced saliva as difficult to swallow
4 - muffled voice or ‘hot potato’ voice different from normal voice (voice cords affected)
4 - stridor (high-pitched, inspiratory in nature)
5 - respiratory distress (tachypnea)
6 - fever (high-grade typically = bacterial cause)
7 - tripod or sniffing position

Answer 9

3 - reduced saliva as difficult to swallow

Typically causes drooling due to difficulty handling secretions

Remember 4 Ds:

• drooling
• dhysphagia
• dysphonia (voice changes)
• distress when breathing

Question 10

If a child has respiratory problems, but then becomes silent. Is this a good or bad thing?

Answer 10

• bad

Suggests child is having impeding decompensation due to exhaustion

Question 11

If epiglottitis is suspected, which of the following should not be performed routinely?

1 - throat inspection
2 - chest X-ray
3 - fundoscopy
4 - blood sample

Answer 11

1 - throat inspection

Should only be performed by ENT doctor for risk of airway obstruction

DO NOT stress the child, move the child to a quiet area and await ENT

Question 12

All of the following can be used when diagnosing epiglottitis, but which is the most useful?

1 - Lateral neck radiograph (‘thumb sign’)
2 - Flexible fiberoptic laryngoscopy (ENT only)
3 - Blood cultures and throat swabs
4 - Clinical diagnosis

Answer 12

4 - Clinical diagnosis

Physical examination and history

Flexible fiberoptic laryngoscopy (ENT only) will show a cherry red epiglottis

Question 13

When treating a patient with suspected epiglottitis, if they require an endotracheal intubation or emergent tracheostomy in A&E or ICU?

Answer 13

• ICU

Must be monitored closley

Question 14

Should antibiotics be prescribed in epiglottitis?

Answer 14

• Yes

Cephalosporins is commonly used (Cephalexin, Ceftriaxone, Ceftazidime, Cefuroxime)

Typically caused by the bacteria Haemophilus influenza type B vaccine, so empirical broad spectrum antibiotics should be given

Question 15

In addition to antibiotics and potential intubation, which of the following is NOT routinely performed in a patient with suspected epiglottitis?

1 - corticosteroids
2 - analgesia
3 - fluids
4 - antihistamines
5 - nebulised adrenaline

Answer 15

1 - corticosteroids

Rarely given, and if so this is on a case to case basis

Patients must also be closely monitored and followed up

Question 16

What is the best treatment/prevention for epiglottitis?

1 - hand sanitisation
2 - Hib vaccine
3 - mask wearing
4 - remaining at home when sick

Answer 16

2 - Hib vaccine