The medical term glottic edema is used to describe an acute swelling of the laryngeal mucosa. Advanced glottic edema poses a risk of suffocation.
What is glottic edema?
Glottic edema is a life-threatening swelling of the mucous membrane (edema) in the larynx. Glottic edema may also be referred to as laryngeal edema. It can be caused by infections, allergies, or medications. Typical symptoms of glottic edema are hoarseness and increasing shortness of breath. Treatment depends on the cause. Quick action is necessary, as death by suffocation is imminent if the larynx is completely obstructed. If there is acute danger of suffocation, intubation or tracheostomy is performed.
Causes
Possible causes of laryngeal edema include infections. These may be caused by bacteria or viruses. In young children, epiglottitis is particularly feared. This is an inflammation of the epiglottis, usually caused by the Haemophilus influenzae type B bacterium. However, diphtheria, especially laryngeal diphtheria, can also result in glottic edema. Diphtheria is caused by the pathogen Corynebacterium diptheriae. Less commonly, glottic edema results from infection with Streptococcus pneumoniae, Staphylococcus aureus, or other beta-hemolytic streptococci. Another cause of glottic edema is an acute allergic reaction. In an allergic reaction, the body reacts to non-infectious foreign substances with an inflammatory response. While skin rashes tend to be considered a mild allergic symptom, glottic edema is a severe anaphylactic allergic reaction. Such an allergic reaction can be caused, for example, by eating nuts or other allergens. Various medications can also cause glottic edema. It occurs more frequently with the use of ACE inhibitors. Glottic edema is also a complication of radiation therapy. Radiotherapy is most commonly used in patients with cancer. Laryngeal edema can also develop after trauma. For example, edema due to gagging would be conceivable.
Symptoms, complaints, and signs
The cardinal symptom of glottic edema is hoarseness. Affected individuals have a raspy voice and increasingly have difficulty breathing (dyspnea). They may also complain of difficulty swallowing. If glottic edema is infectious, it may be accompanied by fever. The more pronounced the swelling, the more likely a so-called inspiratory stridor will be heard. A stridor is an abnormal respiratory murmur that results from a narrowing of the airway. Stridor localized in the region of the larynx sounds like a whistle or like a hiss. The increasing narrowing of the airway worsens the shortness of breath, so that acute choking can occur in an emergency. If the glottic edema is caused by epiglottitis, the swelling of the mucous membranes is often announced in advance. The disease begins quite suddenly and takes a fulminant course. The affected patients suffer from severe sore throat and high fever. Typical of epiglottitis with glottic edema is a slurred speech. Since swallowing is extremely painful for those affected, saliva runs out of their mouths. Large amounts of saliva are also produced (hypersalivation). Glottic edema caused by allergies can be announced by scratching and itching in the throat. Affected patients have to clear their throat frequently. A swollen tongue and redness around the mouth after eating potential allergens may also indicate allergy as the cause of glottic edema.
Diagnosis
The diagnosis can be made fairly quickly based on the characteristic symptoms. If glottic edema is suspected, transfer to a hospital should always be made. One diagnostic measure to confirm the suspected diagnosis is an inspection of the pharynx. Possibly, this can be performed by fiberoptics inserted into the nose. If inflammation is present, the local finding is a bright red and inflamed epiglottis. In all forms of glottic edema, mucosal swelling is evident. Care should be taken when examining the mouth and throat. Examination objects can irritate the tissues so that the mucosa quickly swells even more. There is a risk of death by suffocation.
Complications
In the worst case, glottic edema causes choking or swallowing. In this case, children in particular are at increased risk of choking, and death can occur relatively quickly. The affected person suffers primarily from a deep voice and hoarseness. In most cases, speaking and swallowing are associated with pain. Not infrequently, the difficulty in swallowing also leads to reduced intake of fluids and food, so that dehydration or malnutrition may result. The tongue swells, and a sore throat may become noticeable. Hyperventilation may also occur if breathing is difficult, and the patient may have an itchy throat. Treatment of glottic edema is usually causal and is performed with the help of antibiotics. When taking medication, in most cases there are no further complications and the disease disappears. In severe cases, the affected person may be dependent on artificial respiration in order not to suffocate. Furthermore, no particular sequelae occur and life expectancy is not reduced by glottic edema.
When should one go to the doctor?
Since glottic edema can lead to the death of the affected person in the worst case, treatment is necessary in any case. As a rule, a doctor should be consulted if the patient suffers from difficulty swallowing and has difficulty breathing. Even strenuous activities or sports may no longer be possible, so that the patient’s quality of life is significantly reduced. Furthermore, abnormal breathing sounds often also indicate glottic edema and should be examined by a physician. In severe cases, the disease can lead to suffocation of the affected person. Many patients complain of a persistent sore throat and a scratchy or itchy throat. A swollen tongue also usually indicates glottic edema and must be examined by a physician. In the first instance, the affected person can contact a general practitioner or a hospital. Treatment is always performed in a hospital. In acute emergencies or if the condition is severe, the emergency physician may also be called.
Treatment and therapy
Treatment of glottic edema depends on the cause. Anti-inflammatory glucocorticoids are used in high doses so that the mucous membranes decongest as quickly as possible. In addition, an attempt is made to prevent further swelling by applying a so-called ice tie. An ice tie is a sealable tube that is filled with pieces of ice. The cold leads to vasoconstriction and thus to reduced blood flow. Thus, less fluid leaks into the tissues. If the edema is caused by a bacterial infection, antibiotics are given. Third- and fourth-generation antibiotics have proven particularly effective for epiglottitis. Glottic edema due to allergy is treated with antihistamines. If there is a risk of suffocation, intubation can be performed. Here, an endotracheal tube is inserted between the vocal folds of the larynx into the trachea. This widens the airway and allows external ventilation. A tracheostomy may also be required. This involves surgically gaining access to the trachea. The trachea is opened between the second to fourth tracheal cartilages. This creates a connection between the trachea and the outer air space. This is also known as a tracheostoma. Patients can be artificially ventilated through this tracheostoma until the mucous membranes are swollen down and independent breathing is possible again.
Outlook and prognosis
The prognosis of glottic edema is tied to the course of the disease as well as the use of timely medical care. In an acute form, without an ambulance and prompt treatment, there is a risk of premature death. The edema triggers a decreased air supply, so that the affected person is at risk of suffocation. Normally, edema develops slowly and continuously. The affected person should already consult a doctor if there is a feeling of tightness in the throat or if swallowing difficulties increase. This usually prevents acute situations. Without medical treatment, an increase in symptoms is to be expected. If glottic edema is treated with medication, the prognosis is good.There may be a need for temporary artificial respiration, which leads to a severe impairment of well-being as well as quality of life. However, after the swelling has subsided due to the medication and thus the causative triggers have been treated, a complete recovery can be expected. Due to the experiences as well as the treatment, complications such as anxiety or sore throat may occur. Normally, the physical irregularities gradually recede until freedom from symptoms is achieved. For the emotional problems, follow-up treatment may be necessary for processing what has been experienced so that quality of life is fully restored and anxiety is reduced.
Prevention
Not all glottic edema can be prevented. There is a vaccination against the causative agent of epiglottitis. This is also recommended by the Standing Commission on Vaccination (STIKO). Glottic edema caused by allergy can only be prevented by strictly avoiding known allergens.
Follow-up
As a rule, no special options for follow-up care are possible or necessary in glottic edema. In this case, the patient must first and foremost recognize and treat the reason for the glottic edema. Without treatment, the patient may suffocate in the worst case, so that treatment is necessary in any case. The symptoms are usually treated with the help of medication, although surgical interventions may also be necessary. The medication should be taken according to the doctor’s instructions and, above all, regularly. Possible interactions with other medications must also be taken into account. After surgical interventions, the patient should always rest and take care of his or her body. In most cases, a stay in a hospital is necessary. Strenuous activities or other stressful activities should be avoided during this time. Often, those affected are also assisted with their breathing. If glottic edema is not treated in time, the patient may die in the worst case. In emergencies, therefore, a doctor should always be called or the hospital should be visited directly to prevent further complications. Some variants of glottic edema can be prevented with the help of vaccinations.
What you can do yourself
People in whose environment this disease occurs can be vaccinated against the pathogen. A condition occurring due to allergy, should be addressed by limiting contact with the allergens. In general, it should be noted that there are few self-help options available for this condition. Nevertheless, it is possible to bring about relief by cooling the affected area. However, the ice must not touch the skin directly in order to avoid cold burns. In the case of allergies, taking antihistamines can have a positive effect on the course of the disease. If the disease leads to swallowing difficulties, patients are often dependent on the help of other fellow human beings to take in food and liquids. Above all, care from one’s own family or friends has a positive effect on the course of the disease. Possible psychological complaints or depression can also be prevented by talking to the family or other affected persons. Due to the breathing difficulties, the affected person should refrain from strenuous activities or sports and take it easy on the body. This should be observed especially if the disease occurs due to cancer.
