Epiglottitis

Excerpt

Epiglottitis is an inflammatory condition, usually infectious in origin, of the epiglottis and nearby structures like the arytenoids, aryepiglottic folds, and vallecula. Epiglottitis is a life-threatening condition that causes profound swelling of the upper airways which can lead to asphyxia and respiratory arrest.

Before the development of the Haemophilus influenzae type b vaccine, the majority of cases were caused by H.influenzae and the condition was far more common. In the post-vaccine era, the pathogens responsible are more varied and can also be polymicrobial. For this reason, the term "supraglottitis" is often preferred, as the infections may affect the supraglottic structures more generally. Edema due to infection of the epiglottis and supraglottic structures can be gradually progressive until a critical mass is reached, and the clinical scenario can rapidly deteriorate and lead to airway obstruction, respiratory distress, and death. Symptoms can be exacerbated by patient discomfort and agitation, particularly in children, so any patient with a diagnosis of true supraglottitis must have their airway secured under the most controlled circumstances possible, and every attempt should be made to keep the patient as calm and comfortable as possible until an airway is secured. The airway should not be instrumented for oral exams or endoscopy in the clinic or Emergency Department, and no patient with a potentially unstable airway should be sent to the radiology department for imaging.