Epiglottitis: Diagnosis and Treatment
Jonathan R. Bates MD1
1 Director, Emergency Medical Services, Children's Hospital Medical Center, and Instructor, Department of Pediatrics, Harvard Medical School, Boston
Epiglottitis is a rapid and potentially fatal infection of the supraglottic larynx that causes death by upper airway obstruction and Gram-negative bacteremia with Haemophilus influenzae type B (HIB). The majority of patients (80%) are less than 5 years of age, and the remaining 20% are scattered over the remaining life span. Although sporadically recognized since the early 16th century, the disease has only become well-described since the late 1940s. Initial mortality rates approaching 100% have steadily declined to about 2% with the use of artificial airways and antibiotics.
The key to obtaining a good outcome with available effective therapy in this disease is prompt recognition and rapid initiation of therapy. Delays of even a few minutes can be disastrous. Advanced planning for the handling of such patients in the office, clinic, or emergency room has been effective in avoiding death from such delays. Decisive action can make the difference between death or anoxic damage as an outcome, and complete recovery without sequelae.
CLINICAL PICTURE
The disease typically begins abruptly with the onset of fever greater than 102° F (rectal) and sore throat or difficulty swallowing. These two features of epiglottic inflammation signal the onset of this illness and occur simultaneously or within a few hours of each other.
