ear, nose, and throat disorders
Epiglottitis
Introduction
Epiglottitis is a rapidly progressive bacterial infection of the epiglottis and surrounding tissues that may lead to sudden respiratory obstruction and death. Symptoms include severe sore throat, dysphagia, high fever, drooling, and inspiratory stridor. Diagnosis requires direct visualization of the supraglottic structures, which is not to be done until full respiratory support is available. Treatment includes airway protection and antibiotics. Epiglottitis used to primarily affect children and usually was caused byHaemophilus influenzaetype B. Now, because of widespread vaccination, it has been almost eradicated in children (more cases occur in adults). Causal organisms in children and adults includeStreptococcus pneumoniae,Staphylococcus aureus,nontypeableH. influenzae,Haemophilus parainfluenzae,beta-hemolytic streptococci,Branhamella catarrhalis,andKlebsiella pneumoniae. H. influenzaetype B is still a cause in adults and unvaccinated children. Bacteria that have colonized the nasopharynx spread locally to cause supraglottic cellulitis with marked inflammation of the epiglottis, vallecula, aryepiglottic folds, arytenoids, and laryngeal ventricles. WithH. influenzaetype B, infection may spread hematogenously. The inflamed supraglottic structures mechanically obstruct the airway, increasing the work of breathing, ultimately causing respiratory failure. Clearance of inflammatory secretions is also impaired. 