Epiglottitis

Epiglottitis, also termed supraglottitis or epiglottiditis, is an inflammation of structures above the insertion of the glottis and is most often caused by bacterial infection. Affected structures include the epiglottis, aryepiglottic folds, arytenoid soft tissue, and, occasionally, the uvula. The epiglottis is the most common site of swelling. Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae (see Etiology) can colonize the pharynges of otherwise healthy children through respiratory transmission from intimate contact. These bacteria may penetrate the mucosal barrier, invading the bloodstream and causing bacteremia and seeding of the epiglottis and surrounding tissues. Hib infection of the epiglottis leads to acute onset of inflammatory edema, beginning on the lingual surface of the epiglottis where the submucosa is loosely attached. Swelling significantly reduces the airway aperture. Noninfectious inflammation of any of the structures around the epiglottis may also result from thermal or chemical injury or from local trauma, including blunt trauma to the neck.

In children, signs and symptoms of epiglottitis may develop within a matter of hours, including: Fever, severe sore throat, abnormal, high-pitched sound when breathing in (stridor), painful swallowing, drooling, anxious, restless behaviour etc. Treatment of epiglottitis involves first making sure you or your child can breathe, and then treating any identified infection. The first priority in treating epiglottitis is ensuring that you or your child is receiving enough air. Treatment involves: Wearing a mask, having a breathing tube placed into the windpipe through the nose or mouth, Inserting a needle into the trachea.

Historically, acute epiglottitis was most common in children aged 2-4 years. Studies have shown an annual incidence rate of 0.63 cases per 100,000 persons, and studies of children of all ages with epiglottitis report a seasonal variation in incidence. A retrospective case series of 107 patients admitted to a pediatric hospital's intensive care unit (ICU) from 1997 to 2006 concluded that bacterial tracheitis is now 3 times more likely to be the cause of pediatric respiratory failure compared with viral croup and epiglottitis combined. A retrospective review of a Danish population demonstrated a mean national incidence of epiglottitis in children of 4.9 cases per 100,000 per year in the decade before Hib vaccination. Most studies show no racial predominance for epiglottitis, although a recent study showed higher incidence among black and Hispanic individuals. There also appears to be a 60% male predominance, which has remained true even with the changing epidemiology of epiglottitis.