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Epiglottitis : what it is and the importance of early diagnosis

What is Epiglottitis and what causes it?

The Epiglottis is a leaf shaped flap of cartilage tissue that lies just behind the root of your tongue.  When you swallow, your epiglottis covers your larynx (voice box) stopping food from entering your trachea (windpipe).

When Epiglottitis occurs the epiglottis becomes inflamed and swollen.  It is almost always caused by a bacterial infection.  The most common bacterium that causes Epiglottitis is Haemophilus influenza Type B (HIB).  Other bacteria such as streptococcus pneumonia can also cause Epiglottitis.  Epiglottitis is a medical emergency and if left untreated, it can be fatal.

Symptoms of Epiglottitis

Epiglottitis usually develops rapidly and the symptoms include fever, a severe sore throat, breathing difficulties, drooling and difficulty swallowing.   A person suffering with this condition needs to be treated quickly.   The NHS Choices website advises calling 999 if Epiglottitis is suspected.

If treatment is not started quickly, swelling of the Epiglottis can totally block the airway.  This means a person suffering this condition, will not get the oxygen they need which can lead to collapse and death.

How is Epiglottitis diagnosed and treated?

If someone is suspected to have Epiglottitis, they should be admitted to hospital immediately.  As mentioned above, Epiglottitis is a medical emergency and it should be treated as an emergency by calling 999 for an ambulance.

At a hospital, Epiglottitis is usually diagnosed by the typical symptoms.  Investigations may be carried out to diagnose Epiglottitis and they include; a procedure called a Nasopharyngoscopy which involves a flexible tube being run down the person’s nose into their throat.  The doctor is then able to see through the tube and look for swelling or redness of the epiglottis.  Sometimes an x-ray of the neck may be undertaken as this can show a swollen epiglottis.  Swabs and blood tests may be undertaken to look for signs of infection.

Once diagnosed, the most important treatment is to ensure that a person suffering this condition is getting enough oxygen into their lungs.  A person may need oxygen through a mask or in some cases assistance by way of a ventilator to help them get oxygen into their lungs.

In severe cases, if the epiglottis is swollen and blocking the airway, oxygen is still not able to reach the lungs.  In those situations, a tracheotomy is done.  This involves a small cut being made into the windpipe which allows a tube to pass below the swollen epiglottis so that oxygen is still delivered to the lungs.  If someone has a tracheotomy, they may also need assistance with their breathing using a ventilator.  If someone requires this level of treatment they will have usually been transferred to an Intensive Care Unit.

Antibiotics are usually administered to treat the underlying infection and steroid treatment can also be given to try and reduce the inflammation around the epiglottis.

If Epiglottitis is not treated quickly, the area can become totally blocked and a person may die.  However, if Epiglottitis is treated quickly, the outlook is generally very good.  Recovery usually takes place within about 7 days in children and may take a little longer in adults.

How common is Epiglottitis?

The NHS choices website notes that Epiglottitis is rare in the UK.  During 2011-12, fewer than 600 people were admitted to hospitals in England and Wales with the condition.

In the past Epiglottitis was more common in children between the ages of 2 and 4, but since the introduction of the Hib vaccine, most cases now occur in adults.  In England during 2012, the average age of people admitted to hospital with this condition was 53.  Death from Epiglottitis is also rare, occurring in less than 1 in 100 cases.

Conclusion

Thankfully Epiglottitis is relatively rare following the introduction of the Hib vaccine.  However, when it does occur, early diagnosis and treatment is imperative to avoid a person suffering a lack of oxygen.

As noted above, early detection by clinicians can result in successful management of the condition and an excellent outcome.  Unfortunately, we act for a number of families whose relative suffered from the condition which was not diagnosed promptly and sadly they suffered a lack of oxygen resulting in their death.  With early diagnosis of their condition, those deaths could have been avoided and therefore greater awareness of the condition is required to prevent future occurrences

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