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Epiglottitis

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When to Seek Medical Care

The following combination of signs and symptoms should lead you to go directly to a hospital's emergency department:

  • Sore throat
  • Muffled voice
  • Fever
  • Swallowing problems
  • Fast heartbeat
  • Irritability
  • Respiratory distress characterized by drooling, shortness of breath, rapid shallow breathing, very ill-looking appearance, upright posturing with tendency to lean forward, and stridor (high-pitched sound when breathing in)

Epiglottitis is a medical emergency. Someone who is suspected of having epiglottitis should be taken to the hospital.   Make no attempt at home to inspect the throat of a person suspected of having epiglottitis.  This can cause the windpipe and surrounding tissues to close and an irregular heart beat, which can lead to respiratory arrest (stopping of breathing) and death.

If you experience a sudden onset of the following signs and symptoms, call 911 or go directly to a hospital's emergency department:

  • Sore throat
  • Drooling
  • Inability to speak or swallow
  • Muffled voice
  • Fever
  • Fast heart rate

Call 911 with any sign of respiratory distress, such as stridor, short shallow breathing, fast breathing, or blue discoloration to the skin.

 

Exams and Tests

  • The doctor may perform x-rays or simply look at the epiglottis and the windpipe by laryngoscopy.
    • The doctor may find that the pharynx is inflamed with a beefy cherry red, stiff, and swollen epiglottis.
    • Because manipulation of the epiglottis may result in sudden fatal airway obstruction and because irregular slow heart rates have occurred with attempts at intubation (putting a tube down the throat and placing the person on a machine that helps with breathing), the doctor will use the controlled environment of an operating room or intensive care unit to see the throat structures.
  • Other laboratory tests that doctors use to screen illnesses may include the following:
    • Blood tests to look for infection or inflammation
    • Arterial blood gas, which measures oxygenation of the blood
    • Blood cultures (blood samples that may grow bacteria), which can indicate the cause of the epiglottitis
    • Other immunologic tests looking for antibodies to specific bacteria or viruses
  • These laboratory tests may not be useful in diagnosing epiglottitis until the person is stable. Also, the anxiety from having blood drawn or cultures taken from the throat may cause the unstable epiglottis to close off, completely obstructing the airway and creating an emergency with only a few minutes to correct.
  • Even with all of our modern technology, epiglottitis is not easy to diagnose. An interesting fact is that studies have reported that epiglottitis has been initially misdiagnosed in 36-50% of people. The most common misdiagnosis of epiglottitis is mistaking it as strep throat.
    • Other possible diagnoses include infectious causes such as croup, diphtheria, peritonsillar abscess, and infectious mononucleosis.
    • Noninfectious causes have been mistaken as angioedema edema (swelling of the tissues in the airway), laryngeal inflammation or spasm, laryngeal trauma, cancerous growths, allergic reactions, thyroid gland infection, epiglottic hematoma (trapped blood pocket), hemangioma (abnormal collection of blood vessels), or inhalational injury.
    • It is often easy to mistake epiglottitis for croup. Epiglottitis differs clinically from croup by its worsening progress, lack of a barking cough, and a cherry red swollen epiglottis versus a red nonswollen epiglottis in croup. One way doctors can tell epiglottitis from croup is by x-rays of the neck, which can show the swollen epiglottis.

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