Epiglottitis

Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken.

Epiglottitis is classically described in children aged 2-6 years; 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 in children 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 10% of adults require airway intervention whereas most children do). Unnecessary airway intervention in adults may increase morbidity and mortality, given the relatively high intubation failure rate. Adults should be transferred to ICU level care (with the ability to perform airway intervention) for ventilatory management if they are intubated, or for observation if not intubated in case of deterioration.

Cooperation between the otolaryngologist, intensivist, emergency department physician, anaesthetist, and paediatrician (where relevant) is crucial.

In children with suspected epiglottitis, no action should be taken that could stimulate them, 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 an infection of the supraglottis with the potential to cause airway compromise, due to inflammation and swelling, and should be treated as a surgical emergency until the airway is examined and secured.[1]Flint PW, Haughey BH, Lund VJ, et al. Cummings otolaryngology: head and neck surgery. 7th ed. Elsevier; 2020. Pertinent diagnostic criteria include the classic 'tripod' position of the patient, drooling, high fever, and a toxic appearance.