Acute Epiglottitis: Causes, Symptoms, Treatment

It is an acute inflammatory condition confined to supraglottic
structures, i.e , epiglottis, aryepiglottic folds and
arytenoids. There is marked oedema of these structures
which may obstruct the airway.
Aetiology
It is a serious condition and affects children of 2-7 years
of age but can also affect adults. H. influenzae B is the
most common organism responsible for this condition in
children.
Clinical Features
1. Onset of symptoms is abrupt with rapid progression.
2. Sore throat and dysphagia are the common presenting
symptoms in adults.
3. Dyspnoea and stridor are the common presenting
symptoms in children. They are rapidly progressive
and may prove fatal unless relieved.
4. Fever may go up to 40°C. It is due to septicaemia.
Patient's condition may rapidly deteriorate.
Examination
1. Depressing the tongue with a tongue depressor may
show red and swollen epiglottis. Indirect laryngoscopy
may show oedema and congestion of supraglottic
structure. This examination is avoided for fear
of precipitating complete obstruction. It is better
done in operation theatre where facilities for intubation
are available .
2. Lateral soft tissue X-ray of neck may show swollen
epiglottis (thumb sign).
Treatment
1. Hospitalisation. Essential because of the danger of
respiratory obstruction.
2. Antibiotics. Ampicillin or third genera tion
cephalosporin are effective against H. influenzae and

are given by parenteral route (i.m. or i.v.) without
waiting for results of throat swab and blood culture.
3. Steroids. Hydrocortisone or dexamethasone is given
in appropriate doses i.m. or i.v. TI1ey relieve oedema
and may obviate need for tracheostomy.
4. Adequate hydration. Patient may require parenteral
fluids.
5. Humidification and oxygen. Patient may require mist
tent or a croupette.
6. Intubation or tracheostomy may be required for respiratory
obstruction.