Epiglottitis

Question 1

What is epiglottitis?

Answer 1

Inflammation and swelling of the epiglottis causing severe airway obstruction and significant systemic illness.

Epiglottitis can be life-threatening due to airway compromise.

Question 2

What is the most common infectious cause of epiglottitis?

Answer 2

Haemophilus influenzae type b

The incidence of Haemophilus influenzae type b has decreased due to widespread vaccination.

Question 3

List two other infectious causes of epiglottitis.

Answer 3

• Streptococcus pneumoniae
• Viral (HSV, infective mononucleosis)

Viral infections can also lead to epiglottitis, although they are less common.

Question 4

Name two non-infectious causes of epiglottitis.

Answer 4

• Thermal injuries
• Chemical burns

Foreign body ingestion can also lead to inflammation of the epiglottis.

Question 5

What age group is typically affected by epiglottitis?

Answer 5

Aged 2-7 years

Epiglottitis can occur at any age.

Question 6

What are the acute symptoms of epiglottitis?

Answer 6

• Severe sore throat
• Difficulty swallowing (dysphagia)
• Painful swallowing (odynophagia)
• Muffled ‘hot potato’ voice
• Drooling
• Inspiratory stridor

These symptoms often present suddenly and require urgent medical attention.

Question 7

What signs may indicate epiglottitis?

Answer 7

• Scared and quiet demeanor
• Toxic appearance
• Tripod position
• Extended neck and chin
• Signs of respiratory distress (tachycardia, hypoxia, use of accessory muscles)

The tripod position is a classic sign indicating respiratory distress.

Question 8

What is the ‘thumbprint sign’ in the context of epiglottitis?

Answer 8

A soft tissue shadow on a lateral neck x-ray that looks like a thumb pressed into the trachea.

This radiological sign is indicative of significant swelling of the epiglottis.

Question 9

List two differential diagnoses for sore throat in the context of epiglottitis.

Answer 9

• Acute tonsillitis
• Acute pharyngitis

Other differentials include peri-tonsillar abscess and deep neck space infections.

Question 10

What is a key management step for suspected epiglottitis?

Answer 10

Alert senior paediatricians and anaesthetists.

Immediate expert involvement is critical due to the risk of airway obstruction.

Question 11

What position should a patient with epiglottitis be managed in?

Answer 11

Upright position

This position helps ease breathing and reduces airway obstruction.

Question 12

What are two airway management techniques for epiglottitis?

Answer 12

• Endotracheal intubation
• Surgical airway (e.g. tracheostomy or cricothyroidotomy)

Securing the airway is crucial as epiglottitis can lead to respiratory failure.

Question 13

What additional measures should be taken in the management of epiglottitis?

Answer 13

• Nebulised adrenaline
• High flow oxygen
• IV broad-spectrum antibiotics (ceftriaxone)
• Corticosteroids (dexamethasone)

These measures help reduce inflammation and treat infection.