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Epiglottitis

Epiglottitis should be suspected in patients who have a severe sore throat and odynophagia but a normal oropharyngeal examination. Stridor, a change in voice, and tenderness over the thyroid cartilage also are of concern. Dyspnea, when present, is a serious symptom because of the potential for airway compromise. As the number of children receiving Haemophilus infiuenzae type B immunization rises, the percentage of cases occurring in adults will continue to grow. Antecedent cough or symptoms of an upper respiratory infection (DRI) usually are not present in most cases. Also consider the possibility of bacterial tracheitis, a dangerous condition that may be confused with croup.

Causes

Infectious, chemical, and traumatic is the common cause. H influenzae type B was once the most common cause prior to vaccination. Currently, other organisms such as bacteria, viruses, and fungi are the causes, especially among adults.

  • Various organisms that can cause epiglottitis such as including Streptococcus pneumoniae, Haemophilus parainfluenzae, varicella-zoster.
  • Epiglottitis that are not caused by infection but include hot things that may cause the epiglottis. Heat damage that results in epiglottitis is also known as thermal epiglottitis. Thermal epiglottitis may also occurs due to drinking hot liquids, eating solid foods, or using illicit drugs.
  • Unusual causes of epiglottitis such as include brown recluse spider bites to the ear, which may result in swelling or eating buffalo fish, which may cause an allergiclike reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.

Symptoms

Children

  • Fever ++++
  • Dysphagia +++
  • Worsening sore throat +++
  • Dyspnea ++++

Adults and older children

  • Sore throat ++++
  • Dysphagia ++++
  • Anterior neck tenderness ++++
  • Fever ++

Most children but few adults need an artificial airway established. Predictors of airway intervention include sitting erect, stridor, and shorter time to symptom onset (<8 hours).

Signs

Children

  • Fever ++++
  • Stridor ++++
  • Drooling +++
  • Muffled voice ++++
  • Tripod position with neck extended
  • Children less than 2 years old may look less toxic and be less symptomatic. Half may have a barking cough resembling croup.

Adults

  • Neck tenderness ++++
  • Dyspnea +++
  • Posterior pharyngitis ++
  • Fever ++
  • Dysphonia ++
  • Stridor ++
  • Sitting erect ++
  • Drooling ++

Treatment

Epiglottitis can be treated. If proper treatment is given, the patient can fully recover. Some of the treatment options are:

  • Administration of humidified oxygen. Oxygen will help the patient breathe.
  • Intravenous fluids are given to increase hydration.
  • Antibiotics to treat the infection.
  • Corticosteroids to decrease the swelling of the throat.
   
   

 
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