Epiglottitis

Disease Description (Causes and Symptoms)

• Definition and causes: Epiglottitis is a condition in which acute inflammation of the epiglottis causes swelling that narrows the airway, and it is mainly caused by bacterial infection. Common causative organisms include Haemophilus influenzae type b (Hib), Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus. The incidence has decreased substantially due to Hib vaccination.
• Pathophysiology: The epiglottis rapidly swells due to inflammation and blocks the entrance to the airway, causing respiratory distress, inspiratory stridor, and hypoxia. It progresses rapidly, and the risk of airway obstruction is particularly high in children.
• Main symptoms: High fever, sudden severe sore throat, difficulty swallowing (difficulty swallowing saliva or food), drooling (inability to swallow), hoarseness or voice changes, sitting while leaning forward (tripod position), inspiratory stridor (harsh inspiratory sound), respiratory distress, and cyanosis (late stage). A barking cough (croup) is uncommon (a distinguishing point).

Treatment

• Emergency principles: Securing the airway is the top priority. If there are signs of airway obstruction (severe inspiratory difficulty, cyanosis, or rapid deterioration), prepare immediately for high-risk procedures (intubation or surgical airway management).
• Antibiotics: Administer intravenous (IV) antibiotics early after hospitalization. Empirical treatment is generally based on a third-generation cephalosporin (e.g., ceftriaxone or cefotaxime); if Staphylococcus aureus, particularly MRSA, is suspected, consider adding an anti-staphylococcal agent (e.g., vancomycin). Adjust antibiotics according to culture results. The total treatment duration is usually 7–10 days.
• Airway management: Perform endotracheal intubation in a stable environment or, if intubation is impossible, urgently secure the airway through cricothyrotomy or tracheostomy. Airway management should be planned by an experienced team (anesthesiology, otolaryngology, pediatrics/emergency medicine) working together.
• Conservative treatment and supportive care: Provide oxygen, keep the patient nil per os (NPO), provide fluids, and control pain and fever (antipyretics and analgesics). If necessary, short-term corticosteroid administration may be attempted to relieve epiglottic swelling, at the physician’s discretion. Keep the patient calm and avoid agitation to reduce aspiration.
• Follow-up management: Observation in the intensive care unit is recommended, with continued observation and supportive care until the respiratory condition stabilizes and the inflammation subsides.

Precautions for This Disease (Precautions, Complications, and Self-Care)

• Symptoms requiring an immediate visit to the emergency department: Severe respiratory distress, rapid breathing, inspiratory stridor or cyanosis, persistent drooling or inability to swallow, and decreased consciousness.
• Precautions during testing and examination: Laryngoscopy and oral examination can stimulate the patient and cause airway obstruction, so they should be performed only in a prepared environment, with airway management equipment and a team ready in an emergency.
• Complications: Hypoxia and death due to airway obstruction, pneumonia, sepsis, otitis media, cervical lymphadenitis, and, rarely, meningitis.
• Prevention and self-care: Hib (Haemophilus influenzae type b) vaccination is the most important preventive measure. Children should follow the recommended vaccination schedule. Physicians should educate patients to seek medical attention promptly when symptoms occur. Do not lay the patient down; maintain a comfortable position (sitting), and do not unnecessarily make or stimulate the child to cry.

Pre-Outpatient Visit Checklist (Items to Bring, Information, Test Records, etc.)

• Items/information to bring:
  • List of currently taken medications (including prescription and OTC medications) and allergy history
  • A record of when the illness began and how the symptoms have progressed (when they started and how severely they have worsened)
  • Current vital signs, such as temperature and respiratory rate (measurements, if possible)
  • Notes on observed drooling, difficulty swallowing, and sounds (breathing sounds and cough)
  • Vaccination records (especially whether the Hib vaccine was received)
  • Existing test results, if available (such as chest/neck X-rays and blood tests)
• Instructions before the outpatient visit:
  • If there is severe respiratory distress, cyanosis, or rapid deterioration, go immediately to the emergency department without an outpatient appointment
  • Do not lay the patient, especially a child, down; maintain a comfortable sitting position and avoid stimulation

Examples of General Questions to Ask the Doctor

• "How likely is it that airway management (intubation or surgery) will be needed in this situation?"
• "What type of antibiotic will be prescribed, and what side effects can be expected?"
• "How long will recovery take after treatment, and when can the patient return to daily activities?"
• "Do family members or close contacts need vaccination or additional testing?"

Examples of Disease-Specific Questions

• "If my child has not received the Hib vaccine, what additional preventive measures, such as antibiotic prophylaxis, does the hospital recommend?"
• "Based on the current symptoms, when will the hospital decide whether airway management (intubation or surgery) is needed?"