Epiglottitis – also known as epiglottitis – is a disease caused by bacteria. While this disease rarely occurs in the 21st century, immediate action is required if it is suspected, as it is life-threatening and leads to death if left untreated. Epiglottitis most commonly occurs in children under 6 years of age, but adults can also become infected with epiglottitis.
What is epiglottitis?
Caution: there is a risk of choking with epiglottitis! Epiglottitis is a bacterial infection that can cause life-threatening inflammation of the epiglottis. The epiglottis is part of the larynx and serves as a separation between the trachea and esophagus. During swallowing, the epiglottis overlays the entrance to the larynx and closes the trachea, allowing food and liquid to enter the esophagus. In epiglottitis, the mucous membranes of the epiglottis as well as the tissues of the wider area, such as the muscles of the larynx or lower pharynx, swell. These massive swellings can cause partial or complete obstruction of the trachea, which can lead to acute respiratory distress or suffocation. Epiglottitis should not be confused with pseudocroup, which has similar symptoms. As a rule, children of preschool age contract epiglottitis, and rarely adults. Epiglottitis occurs exclusively in humans.
Causes
The cause of epiglottitis is infection with bacteria. However, the cause or bacterium for epiglottitis differs in children and in adults. In children, the cause is usually an infection with the bacterium “Haemophilus influenzae type B”. The pathogen is transmitted by the so-called contact or droplet infection. In adults, epiglottitis is often caused by pneumococci. The pathogens are “Streptococcus pneumoniae” and “Staphylococcus aureus“. Epiglottitis often occurs without any other previous disease. In exceptional cases, an untreated infection of the nasopharynx may have been present previously, which has spread. However, because of thorough vaccination efforts, epiglottitis is now rarely found.
Symptoms, complaints, and signs
Acute epiglottitis represents a fulminant clinical picture in which severe symptoms develop within a few hours. From complete health, high fever and rapid deterioration of general condition typically occur. Swelling of the epiglottis leads to sore throat and painful dysphagia with increased salivation. Children are unable or unwilling to speak and refuse solid and liquid foods. Saliva typically leaks from the mouth. Another major symptom of epiglottitis is inspiratory stridor, a whistling breathing sound that occurs on inspiration. This is followed by a snoring exhalation, called carping breathing. Increasing swelling of the epiglottis results in obstruction of the upper airway with increasing shortness of breath. To facilitate breathing, patients adopt a typical posture. Sitting, with the upper body bent forward, they take the head in the neck and breathe with the mouth open to expand the airways. The changed language is also remarkable. It impresses as a “droning”, often painful way of speaking. Swollen lymph nodes can often be palpated in the area of the neck and head. Cough, on the other hand, is an atypical symptom of acute epiglottitis and occurs rather rarely.
Diagnosis and course
Epiglottitis is diagnosed by a physician. It is recognized by symptoms such as shortness of breath, high fever, profuse salivation, severe sore throat, and pain when swallowing. Other signs include refusal to eat, difficulty speaking, and refusal to lie on the back. On palpation of the neck, severely swollen lymph nodes are found. If these symptoms are less pronounced, the infection can be detected by means of a blood test. The blood sample can also be used to determine the type of pathogen, which enables more precise treatment of epiglottitis. The symptoms of epiglottitis develop and worsen within a few hours, so that only on the basis of the symptoms the sick person is immediately referred to the hospital.Since the mucous membranes around the epiglottis swell very strongly in epiglottitis, severe respiratory distress occurs in the further course of the disease, which can lead to death by suffocation. If the disease is treated in time, epiglottitis usually heals without consequences.
When should you go to the doctor?
If shortness of breath or breathing disorders persist, a doctor should be consulted. If there are interruptions during night sleep due to breathing difficulties, a visit to the doctor is necessary immediately. If the affected person suffers from sore throat, a feeling of tightness in the throat or severe difficulty swallowing, these symptoms should be examined and treated by a doctor. A visit to the doctor should take place if the vocalization is interrupted or the voice sounds permanently hoarse. If the intake of food is not possible for several days or if it is vehemently refused, the organism is threatened with malnutrition. A visit to the doctor is necessary to initiate medical treatment. If there is a refusal to take in fluids, the risk of dehydration increases. This can lead to a life-threatening condition that must be treated as quickly as possible. As soon as the affected person notices that his mucous membranes in the mouth and throat area are swelling, he should consult a doctor. In the event of a general feeling of illness, noticeable malaise or physical weakness, it is advisable to consult a doctor. If complaints such as dizziness, unsteadiness of gait or disturbances of consciousness occur, a visit to the doctor is urgently required. Problems with heart rhythm, palpitations or elevated blood pressure are cause for concern. To avoid triggering life-threatening conditions or permanent damage, a visit to the doctor should be made as soon as possible.
Treatment and therapy
If epiglottitis is suspected, the sufferer must be hospitalized immediately so that adequate therapy can be administered in a timely manner. Even during transport to the hospital, certain things must be considered. The transport route should be as short as possible and should be under medical or emergency medical escort. Due to the swelling, breathing is impaired, so care should be taken to ensure that the patient is sitting upright. Sufferers panic easily due to decreased breathing, so reassurance should always be used. Sedatives are contraindicated in epiglottitis because they have a negative effect on breathing. The top priority in epiglottitis is to keep the airways clear. Intubation is usually performed as early as possible. This involves inserting a tube into the trachea, which is used for further ventilation. As a further measure, so-called adrenaline sprays can also be administered to reduce the swelling. In extremely severe cases, where the airway is so swollen that intubation is no longer possible, a tracheotomy is performed. After securing the airway, epiglottitis is treated with the help of antibiotics. In children the bacterium is treated with cefotaxime, in adults with cefuroxime. Furthermore, so-called corticosteroids are also used, which have a decongestant and anti-inflammatory effect. Treated in time, epiglottitis heals without consequences.
Outlook and prognosis
The prognosis of epiglottitis is tied to the progress of the disease at diagnosis. With timely discovery and treatment of the inflammation, relief of symptoms is achieved within a few days. Normally, the disease is completely cured within a few weeks. The patient is free of symptoms and does not have to expect any consequential damage. The course of treatment can be prolonged if other diseases are present that also weaken the immune system or if the patient leads an unhealthy lifestyle. In these cases, there are too few defenses in the organism. As a result, the effect of the remedy is delayed to the necessary extent. If the epiglottitis is in an advanced stage, there is a risk of serious complications. In addition to hoarseness, pain and other complaints, the patient may die. In 10-20% of those affected, the disease takes a fatal course. The patient is threatened with death by suffocation if medical care is not provided or is used late. If collapse or acute respiratory distress occurs, an emergency physician is needed.Depending on the patient’s condition, he or she can place an artificial respiratory access in a life-saving measure or in an emergency operation. Drug treatment is then initiated. The patient must remain in hospital until the inflammation has subsided. Timely treatment is therefore essential for a good prognosis.
Prevention
Epiglottitis is caused by bacteria. With the help of a vaccination, the disease can be prevented. Recommended is the vaccination called Haemophilus influeanzae type B – generally known as Hib – by the STIKO (Permanent Vaccination Commission of the Robert Koch Institute) for the infant. As a so-called combination vaccination, the active ingredient against epiglottitis is injected together with other childhood diseases.
What you can do yourself
Children suffering from epiglottitis often wake up at night and show panic behavior because they do not get enough air. To prevent the shortness of breath from increasing due to anxiety, it is important to have a calming effect on the child. Calm conversations with the child and physical closeness support so that the child can breathe slowly again. A window should be open in the sleeping quarters overnight so that there is always enough oxygen in the room. If there is a nighttime attack of shortness of breath, open the window wide. The fresh air is helpful because the coolness helps to reduce the swelling of the mucous membranes. Additionally, turning on hot water in the bathtub or shower may be considered pleasant. Due to the increased humidity of the air, a calming sensation sets in. However, the success of this method has not been statistically proven. In case of epiglottitis, loud talking and shouting should be avoided. The intake of spicy foods, such as chili or pepper is not recommended. These further irritate the respiratory tract and lead to an increase in symptoms. Consumption of harmful substances such as nicotine and alcohol should also be avoided. They also attack the respiratory tract and impair the functioning of the larynx.
