Inflammation of the epiglottis (epiglottitis)

Epiglottitis is inflammation of the epiglottis. The cause is usually an infection with bacteria, especially Haemophilus influenzae type B. Vaccination can help to protect yourself against this germ

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Epiglottitis - briefly explained

In epiglottitis, the epiglottis becomes inflamed and swollen. That can lead to symptoms like

  • high fever
  • Pain when swallowing
  • lumpy language
  • Shortness of breath
  • whistling sound when inhaling (inspiratory stridor).

If you suspect epiglottitis, you should immediately consult a doctor, and if you are short of breath, call the emergency doctor. Hospital treatment is usually necessary. The cause is usually bacteria, such as Haemophilus influenzae type B, against which antibiotics help.

What is epiglottitis?

Inflammation of the epiglottis often occurs in small children, but can also affect older children, adolescents and adults. The triggers are usually bacteria; the Haemophilus influenzae type B germ is particularly typical.

As part of the inflammation, the epiglottis swells so that it can narrow the throat and the entrance to the larynx. This can cause difficulty and pain when swallowing. Breathing can also be impaired or even severely restricted. Within a short time, the rapidly increasing inflammation can narrow the larynx entrance so much that there is a risk of suffocation.

If you suspect epiglottitis, therefore, consult a doctor immediately, and if you are short of breath, call an emergency doctor immediately.

Since the introduction of a vaccination against Haemophilus influenzae B, the number of diseases with the bacterium has steadily decreased. The Standing Vaccination Commission (STIKO) recommends vaccination for all children.

Symptoms

Typical symptoms of epiglottitis are:

  • high fever
  • Pain when swallowing
  • lumpy pronunciation
  • in the further course increasing shortness of breath
  • possibly whistling noise when inhaling (inspiratory stridor)

People cannot even swallow their own saliva, partly due to the pain and swelling of the epiglottis, which is why it sometimes trickles out of their mouths. The disease often takes a rapid course and the condition of the person affected can worsen noticeably within a very short time. This is especially true with children.

Haemophilus influenzae: A typical pathogen causing epiglottitis

© Mauritius / Science Source

Causes and Risk Factors

An infection with bacteria is practically always behind epiglottitis. A typical pathogen, especially in small children, is Haemophilus influenzae type B (HiB). Infection with the bacterium takes place via droplets that are coughed up by infected people, for example, and ingested by other people through the mucous membranes (droplet infection). As part of the infection, the epiglottis becomes inflamed. The mucous membrane swells in this area, so that the epiglottis takes up more space than usual. This can affect both swallowing and breathing. In adults, for example, pneumococci and streptococci can also trigger epiglottitis.

Children up to the age of seven are particularly often affected by epiglottitis; 50 percent of the affected children are between two and four years old. With them, the narrow anatomical conditions in the throat area mean that the swelling of the epiglottis has a particularly rapid negative effect on breathing and swallowing.

If an epiglottis is suspected, a doctor should be alerted immediately; if there is already shortness of breath, the emergency doctor should be alerted immediately.

diagnosis

A rapid onset of the disease with a high fever, difficulty swallowing and lumpy pronunciation as well as a wheezing noise when breathing in (inspiratory stridor) and shortness of breath are typical for epiglottitis. The doctor called will immediately think of epiglottitis if there are signs of disease.

The diagnosis can be clarified with a look in the throat. However, absolute caution is advised here: If the epiglottis is inflamed, breathing is difficult due to the swelling of the mucous membrane. An additional stimulus, such as a throat examination, in which a spatula is pressed on the tongue, can then already result in a complete airway obstruction (laryngospasm). Therefore, an examination of the throat should only take place if it is possible to secure the air supply by inserting a tube into the windpipe (intubation).

therapy

If you suspect epiglottitis, alert a doctor as soon as possible; if you are short of breath, call an emergency doctor. Waiting too long can be risky: Epiglottitis is a sometimes life-threatening disease. The greatest danger comes from the possibility that the larynx will close completely and there is no longer an adequate supply of oxygen. If necessary, the patient with epiglottitis must be artificially ventilated through a tube.If this option is not available quickly enough, a tracheal incision (cricothyrotomy) can be life-saving under certain circumstances.

Children and adults with epiglottitis should not lie down but remain seated. When lying down, the epiglottis falls back and can thus close the larynx entrance even more easily.

Treatment for epiglottitis is usually done in the hospital. Against Haemophilus influenzae B and other bacteria that can cause epiglottitis, antibiotics help, which inhibit the multiplication of the germs or even kill them. The antibiotic should be administered via the vein for at least the first few days. Cortisone, which must be administered in high doses, also has a decongestant effect on the epiglottis.

Prevent

If the sick person has sufficient medical care, all members of the household should be treated preventively with antibiotics to prevent the epiglottitis from spreading. In addition, all small children who have been in close contact with the sick person should receive preventive antibiotics.

Vaccination against Haemophilus inf accelerzae B is possible. In addition to epiglottitis, the bacterium can also cause meningitis. The standing vaccination commission recommends vaccination against Haemophilus inf accelerzae B for all infants from the third month of life. The successes are already visible: the number of diseases has decreased significantly since vaccination was introduced in 1990.

Our expert: Professor Friedrich Bootz

© © W & B / Alexander Perkovic

Consulting expert

Professor Dr. Friedrich Bootz is an ear, nose and throat specialist. From 1987 to 1989 he worked as a senior physician and from 1989 to 1995 as a senior senior physician at the University ENT Clinic in Tübingen. In 1991 he completed his habilitation. From 1995 he was university professor and clinic director in Leipzig and then from 2002 at the University of Bonn. In 2007 he was President and from 2009 to 2012 he was Secretary General of the German Society for Otorhinolaryngology. In 2010 he was awarded an honorary doctorate from the University of Timisoara in Romania, and since then he has also been a visiting professor there.

Important NOTE:
Diagnosis and treatment of a patient are reserved for the doctor. Under no circumstances can this information replace a doctor's visit. However, they can provide additional information and support you in preparing for the doctor's appointment. Medical science is constantly evolving and leading to new findings in diagnostics and therapy. The information given here corresponds to the state of knowledge at the time of publication. Our experts cannot answer individually sent questions.

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