Epiglottitis

Dr. med. Mira Seidel is a freelance writer for the medical team.

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Epiglottitis (inflammation of the epiglottis) is an acute, life-threatening inflammation of the epiglottis caused by bacteria. Typical symptoms are shortness of breath, high fever and salivation. Epiglottitis is more common in preschool children. Thanks to widespread vaccinations, the disease has become rare. You can find out everything you need to know about epiglottitis here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J05J37

Epiglottitis: description

Epiglottitis is an inflammation of the epiglottis, caused by the bacterium Haemophilus influenzae type B. The epiglottis lies above the windpipe and is used to close it while swallowing. Epiglottitis causes swelling of the mucous membranes on and around the epiglottis. As a result, the air duct is narrowed, which can lead to shortness of breath.

The condition is acutely life-threatening as there is a risk of suffocation due to the swollen epiglottis. If you suspect epiglottitis, you should therefore call an emergency doctor immediately. If the patient threatens to suffocate, he must be artificially ventilated as soon as possible. If treated in time, the epiglottis usually heals without serious consequences.

Epiglottitis occurs more frequently in small children between the ages of two and six, but in principle all age groups can suffer from it. An increase in the number of cases in older children and adults has been observed, particularly since vaccination was introduced across the board.

Epiglottitis: symptoms

Epiglottitis is always an emergency. Because shortness of breath can develop within six to twelve hours after the onset of the illness. You should therefore call an emergency doctor immediately, even if it turns out that the symptoms may have been caused by another illness. The following symptoms are likely to be epiglottitis:

• Those affected appear very ill and complain of a severe sore throat when speaking.
• The fever is over 39 degrees Celsius.
• The language is "lumpy".
• Swallowing is usually no longer possible.
• Those affected cannot swallow their own saliva because of the difficulty swallowing, which is why it often leaks out of their mouth.
• Some patients cannot or do not want to speak anymore.
• Breathing is difficult and sounds like snoring (creaky breathing). One of the reasons for this is that a pool of saliva has formed in the throat.
• The jaw is stuck forward and the mouth is open.
• The sitting posture of those affected is bent forward, while the head is tilted back (coachman's seat), because breathing is easier this way.
• Patients have turned pale and / or blue.

Differentiation between epiglottitis and pseudocroup

Epiglottitis can be mistaken for a virus-induced croup. Both epiglottitis and so-called pseudocroup (stenosing laryngotracheitis) are inflammations in the pharynx and therefore have similar symptoms, for example swelling of the larynx. While epiglottitis is a life-threatening clinical picture, croup is usually harmless. The differences are as follows:

	Epiglottitis	Pseudo croup
Pathogen	Mostly the bacterium Haemophilus influenzae	Mostly viruses, e.g. the parainfluenza virus
General condition	Severe malaise, high fever	Usually not significantly affected
Onset of the disease	Suddenly from full health, rapidly deteriorating	Slow, increasing onset of the disease
Typical characteristics	Lumpy speech, severe difficulty swallowing, those affected cannot swallow their own saliva	Barking cough, hoarseness, but no difficulty swallowing, especially at night

Epiglottitis: causes and risk factors

Epiglottitis is usually caused by an infection with the Haemophilus influenzae type B bacterium. Other bacteria such as streptococci and staphylococci are rarely responsible for the inflammation of the epiglottis. Since the introduction of the Haemophilus influenzae type B vaccination (HiB vaccination), the disease has occurred much less frequently.

In some cases, those affected have a banal infection before epiglottitis, such as a runny nose or a slight sore throat. Most of the time, however, those affected get sick out of perfect health. In contrast to the much more common pseudocroup, there is no seasonal increase in epiglottitis, and epiglottitis can occur at any time of the year.

Haemophilus influenzae type B

The bacterium Haemophilus influenzae type B, which causes epiglottitis, colonizes the mucous membrane of the respiratory tract (nose, throat, windpipe) and can lead to inflammation there. It is transmitted by coughing, speaking, or sneezing (droplet infection). The incubation period, i.e. the period between infection and the first symptoms, is two to five days. In the past, the bacterium was mistakenly thought to be the cause of the flu (influenza) and was therefore called "influenzae".

Epiglottitis: examinations and diagnosis

For the experienced doctor, epiglottitis is a "visual diagnosis", which means that he can recognize the disease by simply inspecting the patient. The examinations are limited to the bare essentials, as fear and manipulation in the throat area in children in particular can aggravate shortness of breath and trigger an attack of suffocation. The doctor will only perform a physical examination if there are no breathing difficulties. Equipment for artificial respiration must always be available if it develops.

The doctor inspects the oral cavity and the pharynx with a spatula. In children, the inflamed epiglottitis can be recognized by carefully pushing the tongue away. If necessary, a laryngoscopy or an endoscopy of the trachea and bronchi (bronchoscopy) is necessary. The epiglottis is noticeably reddened and swollen.

If the person is gasping for breath and has turned blue (cyanosis), they should be artificially ventilated (intubated) early on. To do this, a ventilation hose (tube) is placed over the mouth or nose in the throat to secure the airways. Independent breathing or breathing with a resuscitation bag can thus be made possible.

Epiglottitis: treatment

Epiglottitis is treated as an inpatient and intensive care unit. In the clinic, the patient is closely monitored and, if necessary, artificially ventilated. Infusions through a vein provide him with nutrients and regulate the fluid balance. He also receives intravenous antibiotics such as cefotaxime or cephalosporins for a period of ten days. Cortisone (glucocorticoid) is also administered via the vein to reduce the inflammation of the epiglottis. A pump spray with epinephrine helps to relieve acute shortness of breath.

In the event of impending respiratory failure, the affected person is immediately intubated, which may be difficult due to the epiglottitis. An adrenaline spray is also administered. Sedatives such as benzodiazepines should not be given under any circumstances, as these drugs can worsen the dyspnoea. In rare and severe cases, when intubation is not possible due to the swellings, an incision in the trachea (cricothyrotomy, tracheotomy) is performed.

Usually the patient is artificially ventilated for about two days. He will only be discharged if there have been no more complaints for more than 24 hours.

Epiglottitis: measures until the ambulance comes

Until the emergency doctor arrives, you should calm the patient down in the event of epiglottitis, because unnecessary excitement can worsen the shortness of breath. Therefore, under no circumstances should you try to look down your throat and open the windows to get fresh air. Pay attention to the posture the person concerned wants to adopt.

Epiglottitis: Prevention

Since epiglottitis is often triggered by the bacterium Haemophilus influenzae, the HiB vaccination (Haemophilus influenzae type B) is an effective protection. The Standing Vaccination Commission (STIKO) of the Robert Koch Institute (RKI) advises vaccination of all infants from the second Month of life. It usually takes place as a six-fold vaccination, which is also effective against hepatitis B, tetanus, diphtheria, polio and whooping cough.

According to the reduced 2 + 1 vaccination schedule recommended by STIKO since June 2020, infants receive the Hib vaccination in the second, fourth and eleventh month of life. On the other hand, premature babies receive four injection syringes (an additional one in the third month of life). Booster vaccinations are not necessary after complete basic immunization. Primary vaccination is important so that adequate vaccination protection can develop to effectively prevent epiglottitis.

You can find out more about the vaccination against Haemophilus influenzae type B in our article Hib vaccination.

Epiglottitis: disease course and prognosis

With timely therapy, the symptoms improve within a few days and the epiglottitis heals without any consequential damage. If epiglottitis is recognized or treated too late, it can have a fatal outcome.

Asphyxiation is the most dreaded complication of epiglottitis. That's why it still ends fatally in 10 to 20 percent of cases today.

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