Epiglottitis is a cellulitis of the supraglottis that may cause airway compromise. An airway emergency, especially in children, and precautionary measures must be taken.
Epiglottitis is classically described in children aged 2 to 6 years of age; however, it may manifest at any age, including in newborns. In countries that have introduced routine Haemophilus influenzae type B (Hib) vaccination, it is now extremely rare in children and may be more common in adults.
The most common signs are rapid onset of high fever, sore throat, inability to control secretions, classic tripod positioning, difficulty breathing, and irritability. Adults may have a more indolent presentation and may not require airway intervention (only about 11% of adults require intubation whereas most children do).
Cooperation between the otolaryngologist, paediatrician, or emergency department physician and anaesthetist is crucial.
No action should be taken that could stimulate a child with suspected epiglottitis, including examination of the oral cavity, starting intravenous lines, blood draws, or even separation from a parent. Similar caution is required in fulminant acute epiglottitis in adults.
Diagnosis is made on clinical grounds, and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected.
Once the airway has been secured and antibiotics have been initiated, the condition usually resolves rapidly.
Vaccination does not preclude the possibility of epiglottitis or even the possibility of epiglottitis from Haemophilus influenzae.
Epiglottitis is a cellulitis of the supraglottis with the potential to cause airway compromise, and should be treated as a surgical emergency until the airway is examined and secured. Pertinent diagnostic criteria include the classic 'tripod' position of the patient, drooling, high fever, and a toxic appearance.
History and exam
Rahul K. Shah, MD, FAAP
VP, Chief Quality and Safety Officer
Children's National Health System
RKS declares that he has no competing interests.
Scott Brietzke, MD
Walter Reed Army Medical Center
Department of Surgery - Otolaryngology Service
SB declares that he has no competing interests.
Sanjay Parikh, MD
Department of Otorhinolaryngology - Head and Neck Surgery
Albert Einstein College of Medicine
SP declares that he has no competing interests.
Kimsey Rodriguez, MD
Ochsner Health System
Department of Otolaryngology
KR declares that he has no competing interests.
David Parry, MD
DP declares that he has no competing interests.
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