Chapter 23 Epiglottitis
PATHOPHYSIOLOGY
Epiglottitis is an acute bacterial infection of the epiglottis and the surrounding areas (the aryepiglottic folds and the supraglottic area) that causes airway obstruction. The infection is caused by Haemophilus influenzae type B or, on rare occasions, by staphylococci, streptococci, pneumococci, or Candida albicans. The use of H. influenzae type B vaccine in infants has resulted in a dramatic reduction in the incidence of epiglottitis. Onset is sudden, and infection progresses rapidly, causing acute respiratory difficulty. This condition requires emergency airway stabilization and medical measures, since a complete airway obstruction may occur due to swelling of the epiglottis. If left untreated, the outcome can be fatal.
CLINICAL MANIFESTATIONS
1. Respiratory difficulty, which can progress to severe respiratory distress in a matter of minutes or hours (dyspnea)
2. Dysphagia, constant drooling
4. Edematous, cherry-red epiglottis
6. Breathing in upright position with head extended forward (classic “tripod” position)
LABORATORY AND DIAGNOSTIC TESTS
1. Oxygen saturation—decrease in the amount of oxygen
2. Arterial blood gas values—decreased pH, decreased partial pressure of oxygen (Po2), increased partial pressure of carbon dioxide (Pco2)
3. Lateral neck radiographic study—to confirm diagnosis. The epiglottis will be swollen, and the hypopharynx will be dilated. This is known as the “thumb” sign.
4. Throat and blood cultures—to rule out other bacterial infections
5. Direct laryngoscopy—to confirm diagnosis; performed in operating room to prevent complications
