Epiglottitis

What is epiglottitis?

A life-threatening infection causing inflammation and swelling of the epiglottis, leading to rapid airway obstruction.

What organism most commonly causes epiglottitis today?

Streptococcus species (due to Hib vaccination).

What organism historically caused most cases of epiglottitis?

Haemophilus influenzae type b (Hib).

What age group is most affected by epiglottitis?

Children 2–7 years, though can occur at any age.

What are risk factors for epiglottitis?

• Unvaccinated status

• Recent URI

• Immunocompromise

• Trauma to throat

What is the pathophysiology of epiglottitis?

Infection → inflammation → edema of epiglottis and surrounding tissues → airway narrowing → risk of complete obstruction.

What are classic symptoms of epiglottitis?

• Sudden fever

• Severe sore throat

• Dysphagia

• Odynophagia

• Drooling

What symptoms suggest severe airway compromise in epiglottitis?

• Stridor

• Tripod positioning

• Muffled voice

• Respiratory distress

What physical exam findings are characteristic of epiglottitis?

• Drooling

• Tripod posture

• Toxic appearance

• Muffled “hot potato” voice

Why should the throat not be examined with a tongue depressor in suspected epiglottitis?

It may trigger airway obstruction.

What is the preferred imaging modality for epiglottitis?

Lateral neck X-ray if the airway is stable.

What X-ray finding is classic for epiglottitis?

Thumbprint sign (enlarged epiglottis).

What is the gold standard for diagnosing epiglottitis?

Direct visualization via laryngoscopy in a controlled airway setting.

What laboratory findings may be seen in epiglottitis?

• Leukocytosis

• Elevated CRP

• Elevated ESR

What are the treatment goals for epiglottitis?

• Protect airway

• Treat infection

• Reduce inflammation

What is the most important initial management step in epiglottitis?

Airway stabilization.

What pharmacologic therapy is used for epiglottitis?

IV ceftriaxone or IV cefotaxime plus vancomycin if MRSA risk.

What adjunct therapy may be used in epiglottitis?

IV corticosteroids to reduce airway edema.

What non-pharmacologic measures are essential in epiglottitis?

• Keep child calm

• Avoid agitation

• Humidified oxygen

• Prepare for intubation

What are major complications of epiglottitis?

• Complete airway obstruction

• Respiratory arrest

• Sepsis

• Pneumonia

What is the most life-threatening complication of epiglottitis?

Airway obstruction.

What symptoms indicate impending airway failure?

• Stridor

• Drooling

• Tripod posture

• Inability to swallow secretions

What follow-up is required after epiglottitis treatment?

Monitor airway stability and clinical improvement

What preventive measure dramatically reduced epiglottitis incidence?

Hib vaccination.

What conditions mimic epiglottitis?

• Croup

• Bacterial tracheitis

• Peritonsillar abscess

• Retropharyngeal abscess

• Foreign body aspiration

What feature helps differentiate epiglottitis from croup?

Epiglottitis has drooling and tripod posture

What feature helps differentiate epiglottitis from bacterial tracheitis?

Tracheitis has thick purulent secretions and less dramatic drooling.

What feature helps differentiate epiglottitis from peritonsillar abscess?

Peritonsillar abscess has uvular deviation and unilateral swelling.

What feature helps differentiate epiglottitis from retropharyngeal abscess?

Retropharyngeal abscess has neck stiffness and pain with extension.