Epiglottitis

Epiglottitis Overview

Epiglottitis is a medical emergency that may result in death if not treated quickly. The epiglottis is a flap of tissue that sits at the base of the tongue that keeps food from going into the trachea, or windpipe, during swallowing. When it gets infected and inflamed, it can obstruct, or close off, the windpipe, which may be fatal unless promptly treated.

Respiratory infection, environmental exposure, or trauma may result in inflammation and infection of other structures around the throat. This infection and inflammation may spread to involve the epiglottis as well as other upper airway structures. Epiglottitis usually begins as an inflammation and swelling between the base of the tongue and the epiglottis. This may cause the throat structures to push the epiglottis backward. With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to suffocation and death. 

Autopsies of people with epiglottitis have shown distortion of the epiglottis and its associated structures including the formation of abscesses (pockets of infection). For unknown reasons, adults with epiglottic involvement are more likely than children to develop epiglottic abscesses.

• Epiglottitis was first described in the 18th century but was first accurately defined by Le Mierre in 1936. In fact, although George Washington's death in 1796 was attributed to quinsy (today we call it peritonsillar abscess), which is a pocket of pus behind the tonsils, it was actually due to epiglottitis.
  
  • In the past, epiglottitis was more common in children than in adults. This difference was believed to be because of the smaller diameter of children's epiglottic opening when compared to adults.
    
  • A little narrowing of the windpipe can dramatically increase the resistance of an airway, making breathing much more difficult.
• A conservative estimate of the incidence of epiglottitis is 10-40 cases per million people in the United States.
  
  • In the past, Haemophilus influenzae type b (or Hib) was the most common organism related to epiglottitis. Since 1985, with the widespread vaccination against Hib, the overall incidence of the disease among children has dropped dramatically.
    
  • Epiglottitis caused by Hib has a unique distribution in that it typically occurs among children aged 2-7 years and has not been reported among Navajo Indians and Alaskan Eskimos.
    
  • Epiglottitis in the very young (younger than 1 year of age) is unusual and occurs in only about 4% of cases.

Epiglottitis Causes

Causes of epiglottitis include infectious, chemical, and traumatic agents. Infectious is the most common. H influenzae type b was once the most common cause prior to vaccination. Currently, other organisms such as bacteria, viruses, and fungi are the causes, especially among adults.

• Various organisms that can cause epiglottitis include Streptococcus pneumoniae, Haemophilus parainfluenzae, varicella-zoster, herpes simplex virus type 1, and Staphylococcus aureus, and others.
  
• Other types of epiglottitis that are not caused by infection include hot things that may injure the epiglottis. Heat damage that results in epiglottitis is also known as thermal epiglottitis. Thermal epiglottitis occurs from drinking hot liquids, eating solid foods, or using illicit drugs such as inhalation of metal pieces from crack cocaine pipes or the tips of marijuana cigarettes. In these cases the epiglottitis from thermal injury is similar to the illness caused by infection.
  
• Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result in swelling or eating buffalo fish, which may cause an allergic-like reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.