Epiglottitis

Epiglottitis involves inflammation and swelling of the epiglottis, usually due to infection. The epiglottitis can completely occlude the airway within hours. Epiglottitis is a life-threatening emergency.

The key causes of epiglottis are:

  • Haemophilus influenzae type B (the leading cause but now rare due to vaccination)
  • Streptococcus pneumoniae

 

Epiglottitis can occur at any age, including adulthood. The typical age is 2-7 years.

 

Presentation

Epiglottitis can present similarly to croup but with a more rapid onset and some additional features.

Typical symptoms include:

  • Sore throat
  • Difficulty swallowing (dysphagia)
  • Painful swallowing (odynophagia)
  • High fever
  • Stridor
  • Drooling
  • Muffled “hot potato” voice

 

On general inspection, the child may be:

  • Scared and quiet
  • Toxic appearance
  • Sat in the tripod position (sat forward with a hand on each knee)
  • Extending their neck and chin

 

TOM TIP: In exams, suspect epiglottitis in an unvaccinated child with a high fever, sore throat, dysphagia, and drooling.

 

Investigations

Investigations should not be routinely performed in suspected epiglottitis. They may scare the child and worsen the airway obstruction.

Lateral x-ray of the neck characteristically shows the “thumb sign” or “thumbprint sign”. This is a soft tissue shadow that looks like a thumb pressed into the trachea, caused by the oedematous and swollen epiglottis.

 

Management

Epiglottitis is an emergency, with an immediate risk of the airway closing. Avoid upsetting the child, as this may worsen the airway obstruction. Examining the child is not recommended. Alert the most senior paediatrician and anaesthetist available. Oxygen may be administered by holding the mask close to the child but not putting it on them.

Management involves securing the airway. Preparations need to be made to intubate at any time. Intubation is often difficult and needs to be performed in a controlled environment with facilities available to do a tracheostomy (intubation through the neck) if the airway closes.

Once the airway is secure, IV antibiotics (e.g., ceftriaxone) are initiated. Systemic steroids may also be used.

 

Last updated February 2025

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