Otolaryngology: Epiglottitis

Epiglottitis

Definition

  • Inflammation of the Epiglottis and Supraglottic Structures
  • Can Cause Life-Threatening Airway Obstruction
  • Rare Since HiB Vaccination

Causes

  • Infection – Most Common
    • Hemophilus influenzae Type B (HiB)
    • Staphylococcus aureus
    • Streptococcus pneumoniae
  • Burns/Thermal Injury
  • Direct Trauma
  • Caustic Ingestion
  • Chronic Granulomatous Disorders

Presentation

  • Sore Throat
  • Respiratory Distress
  • Stridor
  • “Sniffing”/“Tripod” Positioning – Trunk Leaned Forward with Neck Hyperextended
    • Maximizes Airway Diameter
  • Dysphagia
  • Drooling
  • Hoarse Voice

Diagnosis

  • *Based on Clinical Presentation
  • Definitive Diagnosis: Direct Visualization by Laryngoscopy
    • Avoid if Acute on Onset with Impending Airway Obstruction – Requires Immediate Airway Control
  • Lateral Neck XR – “Thumb Sign” (Enlarged Epiglottis)

Treatment

  • Primary Initial Concern: Airway Management
    • Intubation Indications:
      • Signs of Near-Total Obstruction
      • > 50% Obstruction
      • Young (< 6 Years Old)
    • If Maintaining Oxygenation: Intubate in the OR (Controlled Setting)
    • If Not Maintaining Oxygenation: Attempt Emergent Bedside Intubation Only Once with Low Threshold for Cricothyroidotomy
  • Definitive Treatment: Empiric Antibiotics