Sinusitis

What does an inflamed epiglottis look like? Symptoms and treatment of epiglottitis

Epiglottitis is an inflammation of the epiglottis area and the surrounding tissue, which can result in severe impairment of respiratory function due to a sharp narrowing of the larynx area.

The epiglottis serves as a “door” that protects the airways from food and liquid entering them; it covers the entrance to the larynx and trachea during swallowing. Due to damage, injury or inflammation of the epiglottis, it can sharply increase in size and almost completely block the entrance to the larynx and trachea.

General information

Epiglottitis most often occurs in children under 4 years of age, although older children and adults can also get sick. Usually the disease is severe, accompanied by symptoms of respiratory failure.

Epiglottitis requires medical care, often in a hospital. Over the past 20 years, thanks to active control of infections through vaccination, episodes of epiglottitis have become less common, although they still occur.

Reasons

There are several main factors leading to pathology of the epiglottis. This:

infectious lesions,
traumatic effects (blows, neck bruises, foreign objects, burns),
exposure to external factors that damage the epiglottis (smoking, inhalation or ingestion of chemicals),

Infectious cause is the most common. The main causative agents of epiglottitis include:

hemophilus influenzae type B,
influenza virus,
pneumococcal infection,
streptococcus of all possible types,
Candida fungus, causative agent of candidiasis,
varicella zoster virus.

Less commonly, epiglottitis is caused by viruses or microbes of another nature, usually with a decrease in immune defense and general allergization of the body.

Risk factors for developing epiglottitis are:

belonging to the male gender,
dark skin,
living in large cities, in crowded conditions,
weakening of the immune system.

Species

According to clinical manifestations, the following are distinguished:

edematous epiglottitis,
infiltrative,
abscessive form of epiglottitis.

Symptoms of epiglottitis

Epiglottitis begins as a cold infection. It manifests itself:

temperature rise,
general malaise,
runny nose, sneezing, nasal congestion.

Within a few hours, the disease quickly develops and gives typical manifestations of epiglottitis:

high fever,
heavy breathing with whistling, noise and participation of auxiliary muscles,
difficulty swallowing,
sore throat with pain and redness,
anxiety, fear, irritability,

The patient takes a forced sitting position with the neck stretched, the mouth opening and the tongue sticking out.

When breathing, the wings of the nose swell,
the voice is sharply muffled,
salivation is pronounced.

Signs of a lack of oxygen are formed - blueness around the mouth, at the tips of the fingers, difficulty breathing.

A blood test reveals a pronounced inflammatory reaction with an increase in leukocytes and ESR.

Diagnostics

The diagnosis is made based on complaints and examination of the throat and epiglottis.

But examining a child with epiglottitis is difficult, since attempts to examine the throat can lead to breathing problems due to the edematous epiglottis blocking the windpipe. In such cases, they resort to an X-ray of the throat to determine the degree of swelling.

Another diagnostic method is to examine the epiglottis with a special flexible fiberscope in an operating room using anesthesia and tracheal intubation methods.

If epiglottitis is suspected, a general blood test and biochemistry, oropharyngeal culture are also performed to determine the pathogen and its sensitivity to antibiotics.

Treatment of epiglottitis

Epiglottitis is treated by ENT doctors and resuscitators in intensive care units.

If this pathology is suspected, an ambulance must be called and immediate hospitalization in intensive care or intensive care. First of all, in case of severe swelling of the epiglottis and breathing problems, intubation is required - the introduction of a breathing tube that does not completely block the lumen.

Treatment is carried out according to plan:

injection of antibiotics (into a muscle or vein),
administration of glucose and nutritional solutions during the stay in intensive care,
humidifying the air, breathing a mixture of oxygen and air,
as the condition improves, transfer to the ward and continuation of anti-inflammatory, anti-edematous and antimicrobial therapy.

Complications

The most dangerous complication of epiglottitis is acute asphyxia - blocking of the airways by a swollen epiglottis.

Another dangerous complication is pulmonary edema, which can occur as a result of a severe lack of oxygen. Infection may spread from the epiglottis area with the formation of pneumonia, meningitis or sepsis.

Prevention

Since in the vast majority of cases epiglottitis is caused by Haemophilus influenzae, one of the most effective methods of prevention is vaccination against Haemophilus influenzae. It is administered to children as part of the national vaccination calendar - the Pentaxim or ACT-Hib vaccine.

Epiglottitis is an acute, life-threatening inflammation of the epiglottis and surrounding tissues, often leading to obstruction of the airway. Children of preschool and school age are most often affected, so epiglottitis is considered a childhood disease.

However, this infection can also affect adults. The incidence decreased significantly when children began to be vaccinated against Haemophilus influenzae (vaccination against Haemophilus influenzae infection) with the Pentaxim and DTP vaccines against Haemophilus influenzae type B.

The purpose of the epiglottis (cartilage of the larynx) is to close the gap in the throat to prevent food from entering the respiratory tract. Therefore, we are unable to swallow and breathe at the same time. If inflammation of the epiglottis occurs, the entrance to the trachea is reduced or closed altogether.

The pathology occurs quickly, severely and is characterized by the development of serious complications and high mortality.

The main causes of epiglottitis:

I. Infectious:

1. Haemophilus influenza type b is the main causative agent of the disease.

2. Pneumococcal infection.

3. Streptococci.

4. Varicella zoster – the virus of chickenpox and herpes zoster.

4. Yeast-like fungi of the genus Candida.

II. Non-infectious:

1. Mechanical, chemical or thermal damage to the larynx.

2. External factors: smoking, drug addiction.

Risk factors for epiglottitis:

Male gender (epiglottitis is 2 times more common in men than women).

Race. People with dark skin are more susceptible to infection than people with white skin.

Various health care options, including childhood vaccinations, which are not always available in less affluent populations.

Place of residence – in densely populated cities it is easier to become infected.

Weak immune system (previous allergization, perinatal encephalopathy, concomitant lymphogranulomatosis (and associated chemotherapy), sickle cell anemia, agammaglobulinemia, post-splenectomy condition).

There are 3 forms of epiglottitis:

Edema;

Abscess;

Infiltrative.

Symptoms of epiglottitis:

Epiglottitis may be preceded by an upper respiratory tract infection. The disease can progress rapidly over 2–5 hours. The main danger of this disease is complete blockage of the airways due to inflammation and swelling of the epiglottis.

Signs of epiglottitis:

High body temperature;

Difficulty breathing;

Sore throat;

Difficulty swallowing;

Noisy wheezing breathing;

Restlessness and irritability;

Blueness of lips.

Both adults and children take a characteristic pose - they sit upright and stretch their necks forward. So they strive to increase the lumen of the larynx, which has suddenly narrowed due to thickening of the epiglottis.

Diagnosis of epiglottitis

Diagnosis is carried out only after restoration of the airway lumen. However, examining the throat is often difficult, since it is impossible to push the tongue away with a spatula - this can cause reflex laryngospasm and lead to airway obstruction. Especially in children. Then an X-ray of the neck is taken in a lateral projection. The radiograph shows an enlarged epiglottis. In adults, the epiglottis is examined using a laryngoscope. In this case, the doctor should have at hand everything necessary for tracheal intubation.

In case of epiglottitis caused by infection, a microscopic examination of a smear from the pharynx is required to determine the causative agent.

Differential diagnosis of epiglottitis

Differential diagnosis of epiglottitis is carried out with the following diseases:

Acute stenosing laryngotracheitis (false croup syndrome),

Retropharyngeal abscess,

Abscess of the root of the tongue,

Bronchial asthma,

Thermal and chemical damage to the mucous membrane of the oropharynx,

Foreign body of the larynx,

Subglottic hemangioma,

Laryngeal papillomatosis,

Multiple soft tissue tumors of the oropharynx,

Bronchiolitis,

Treatment of epiglottitis

Patients with symptoms of epiglottitis must be urgently hospitalized. They should only be transported in a sitting position to avoid obstruction of the airways by the sunken epiglottis. Treatment of inflammation of the epiglottis is carried out simultaneously by otolaryngologists and resuscitators.

Emergency care for epiglottitis is aimed at restoring impaired breathing. It involves inhalation with humidified oxygen or using an oxygen mask. Complete obstruction of the airway requires tracheal intubation.

After restoration of impaired breathing, they proceed to antibiotic therapy (using cephalosporins in combination with aminoglycosides (the course of treatment lasts 7-10 days), infusion therapy and immunocorrection.

Forecast and prevention of epiglottitis in children

The outcome of epiglottitis in children is largely determined by the timeliness of diagnosis, emergency care and initiation of rational antibiotic therapy. With adequate ventilation, mortality does not exceed 1%. The main problem in the early recognition of epiglottitis in children is the large number of diagnostic errors at the prehospital stage, the rapid progression of symptoms, leading to the death of the child from asphyxia within a few hours.

Prevention of epiglottitis and other Hib infections requires widespread coverage of young children with preventive vaccination against Haemophilus influenzae infection. Currently, vaccinations against hemophilus influenzae are carried out with the drugs Hiberix, Act-HIB and the complex vaccines Pentaxim and Infanrix GEXA.

We really hope that you, the reader, understand the need for early recognition of the disease in order to prevent an unfavorable outcome!

Contact a specialist (ENT doctor) on time.

Epiglottitis is an inflammatory disease of the epiglottis and surrounding tissues of the hypopharynx, which sharply disrupts the patency of the airways and leads to their obstruction. This pathology of bacterial etiology is accompanied by dysphonia, dysphagia, sore throat, fever, and wheezing.

With epiglottitis, the upper part of the larynx becomes inflamed along with the surrounding tissue. The disease develops as in children, the same in adults, but most often in boys 2-5 years old. The pathology is severe and is characterized by the development of serious complications and high mortality.

The epiglottis is a movable cartilage that has the shape of a petal and covers the entrance to the trachea during swallowing. This is a kind of valve or door that protects the respiratory system from food and liquid. When inflamed, the epiglottis increases in size and blocks the entrance to the larynx and trachea, blocking the flow of air into the lungs. With a sharp impairment of respiratory function, there are practically no visible changes in the pharyngeal mucosa.

Etiology

In addition to pathogenic biological agents, the following etiological factors can cause epiglottitis:

Direct injury to the throat - a blow, as well as other injuries and wounds to the neck.
Thermal burn when eating hot food.
Chemical burn of the throat with acids or alkalis.
Injury to the larynx.
Smoking, drug addiction.

Pathogenesis

Haemophilus influenzae is a gram-negative microorganism, the pathogenicity factors of which are the ability to form capsules and develop purulent inflammation at the site of penetration.

The bacterium enters the epithelium of the respiratory organs, destroys the epithelial barrier and causes local inflammation. The epiglottis and upper part of the larynx swell. The pathological process involves the surrounding tissue, muscles and perichondrium. The epiglottis shifts posteriorly and causes pain, which can lead to asphyxia and even death.

Respiratory viruses cause damage and rupture of capillaries, the appearance of small hemorrhages, and damage to the epithelium. These processes contribute to the unhindered penetration of bacteria into the submucosal layer, where a focus of inflammation is formed.

Risk group:

Men get epiglottitis more often than women.
People who are in close groups - at school, nursery, office - get sick faster.
Black people are more susceptible to infection and development of pathology than people with white skin.
The disease is more common among city residents than among rural residents.
Individuals with weakened immune systems are susceptible to viruses and bacteria.
Allergy sufferers.
Children with perinatal encephalopathy.
Persons suffering from incurable blood diseases - lymphogranulomatosis.
Those who have had a splenectomy (surgery to remove the spleen).

Symptoms

Epiglottitis begins like a common cold and is manifested by malaise, fever, sneezing, runny nose, and nasal congestion.

The main manifestations of acute epiglottitis are: pain, throat hyperemia, intoxication syndrome. The patient experiences difficulty breathing, the epiglottis interferes with swallowing, and salivation and drooling increase. After some time, the voice becomes muffled, breathing becomes hoarse, whistling, and noisy. It becomes difficult for the patient to breathe, lips and fingertips turn blue, irritability, anxiety and fear gradually increase. The patient's forced posture is an elongated neck, an open mouth and a protruding tongue.

Epiglottitis in children

Usually the development of pathology is preceded by or. The disease manifests itself in children with a characteristic triad of symptoms: difficulty breathing, excessive salivation and sore throat. Most experience ear pain and pain on palpation of the neck.
The child becomes restless, excited, his voice changes to the point of aphonia, and the process of swallowing food is disrupted. As the pathology progresses, shortness of breath increases, heart rate increases, acrocyanosis, sweating, and marbling of the skin appear. The child is in a semi-sitting position, gasping for air. It is impossible to lay him on his back. Breathing becomes stenotic, the pulse is weak, a rare dry cough appears, and vomiting “coffee grounds” is possible.

Inflammation of the epiglottis in children develops rapidly, symptoms increase and complete obstruction of the airways can occur within a few hours.

Children die from acute respiratory failure, aspiration of vomit, and hypoxic coma.

Diagnostics

Diagnosis of the disease is carried out in a hospital after restoration of impaired breathing and the general condition of the patient. It begins with a study of complaints, anamnesis and examination of the throat and epiglottis.

An examination of children with epiglottitis is carried out by a pediatric ENT doctor in the intensive care unit.

Instrumental methods for studying patients with epiglottitis include: fibrolaryngoscopy, pharyngoscopy, laryngoscopy, with the help of which dark cherry infiltration of the root of the tongue, hyperemia of the epiglottis, decreased mobility, and swelling of surrounding tissues are revealed.

In a microbiological laboratory, the mucus is examined for microflora and the sensitivity of the causative agent to antibacterial agents is determined.

X-ray diagnostics can detect an enlarged shadow of the epiglottis and determine the degree of swelling of the throat.

Treatment

Patients with symptoms of epiglottitis must be urgently hospitalized. They should only be transported in a sitting position to avoid obstruction of the airways by the sunken epiglottis. Treatment of the pathology is carried out simultaneously by otolaryngologists and resuscitators.

After restoration of impaired breathing, they proceed to antibiotic therapy, infusion therapy and immunocorrection.

Antibiotic therapy consists of prescribing cephalosporins - Cefuroxime, Cefotaxime, Ceftriaxone, Ceftazidime and penicillins - Amoxiclava.
Immunocorrection – “Polyoxidonium”, “Licopid”, “Bronchomunal”.
Infusion therapy - saline solution, Disol, Ringer's solution, Lactasol.

Preventive measures

There is a specific prevention of epiglottitis - vaccination. It is usually performed on children under 5 years of age. A vaccine has now been developed for older children and adults whose immune systems are weakened.

Nonspecific prevention consists of regular hand washing, exercise, hardening, a balanced diet and strengthening the immune system. You should protect your throat from injuries and burns, avoid eating hot food, lead a healthy lifestyle, and stop smoking.

Video: epiglottitis, in the program “Live Healthy”

This disease is also characterized by painful and difficult swallowing, drooling, hoarse breathing, muffled voice, and irritability. The lips and skin of a person suffering from epiglottitis are often bluish.

Sometimes the patient is restless. Both adults and children take a characteristic pose - they sit upright and stretch their necks forward. So they strive to increase the lumen of the larynx, which has suddenly narrowed due to thickening of the epiglottis.

There are edematous infiltrative and abscess forms of epiglottitis. In the edematous form of the disease, the patient experiences a high temperature (up to 39°), severe sore throat, pain on palpation of the neck, severe swelling of the mucous membrane of the epiglottis.

With infiltrative and abscessive epiglottitis, fever, severe sore throat, and severe shortness of air are also observed. The tongue is covered with a gray coating, the epiglottis is swollen. For the abscess form, the doctor, during laryngoscopy, can see pus visible through the swollen mucous membrane.

Description

The larynx is a tube of cartilage, muscle, and mucous membrane that connects the pharynx and trachea. And the epiglottis (epiglottis) is a thin leaf-shaped cartilage that performs the function of a valve. It closes the entrance to the larynx when swallowing so that food does not enter there. It is because of the epiglottis that a person cannot breathe and swallow at the same time. The epiglottis is located above the root of the tongue.

There are many causes of epiglottitis. They are divided into infectious and non-infectious. Infectious causes are:

the most common causative agent of epiglottitis is the bacterium Haemophilus influenzae type b; the same microorganism can cause meningitis and pneumonia;
streptococci;
varicella zoster virus.

In addition, epiglottitis can develop as a result of a chemical or thermal burn, trauma, foreign body, or the use of heroin, cocaine, or smoking drugs. These are non-infectious causes of epiglottitis.

There are also risk factors for this disease. This

gender - epiglottitis develops more often in men than in women;
weakened immune system;
close contact with carriers of infections that cause this disease.

If epiglottitis is not treated, complications may occur. The very first thing is obstruction of the respiratory tract, leading to an acute lack of oxygen. And this can end in death. Also, as a complication of epiglottitis, pneumonia, pericarditis, and effusion pleurisy (fluid accumulation in the pleural cavity) can develop. The cervical lymph nodes may also become inflamed.

First aid

Epiglottitis is a condition that threatens the patient's life. Therefore, at the first symptoms it is necessary to call an ambulance. But it is forbidden to examine the throat yourself, as this can lead to blockage of the airways. It is impossible to force the sufferer to change his body position.

Doctors will take the necessary measures to restore the lumen of the airways. He may be wearing a mask to supply oxygen. In some cases, tracheal intubation is necessary - the insertion of a plastic tube into the trachea through which oxygen is supplied. The tube can remain with the patient for up to three days.

Diagnostics

In case of epiglottitis caused by infection, a microscopic examination of a smear from the pharynx is required to determine the causative agent.

Treatment

Epiglottitis is treated in a hospital. The room in which the patient is located must be well humidified to prevent the respiratory tract from drying out.

First of all, it is necessary to ensure normal breathing. To prevent dehydration and exhaustion, nutrients and fluids are given intravenously. Antibiotics are also given intravenously to clear up the infection.

Prevention

Nowadays children are vaccinated against Haemophilus influenzae (vaccination against hemophilus influenzae infection), this protection should not be neglected. It is carried out with the Pentaxim vaccine or DTP/vaccine against Haemophilus influenzae type B.

It is also necessary to promptly treat infectious diseases of the nose and throat. If there is already one person in the family with epiglottitis, the doctor prescribes antibiotics to the rest of the family members to prevent this disease.

Infiltration stage: manifested by thickening of the area where inflammation develops, redness, swelling, and pain.
Abscessation stage: at the site of the infiltrate (dense, swollen area of inflammation), a cavity filled with pus is formed.

Reasons

An epiglottis abscess develops as a complication of epiglottitis (inflammation of the epiglottis). The cause of epiglottitis is an infectious process, most often caused by:
- Haemophilus influenzae (cause of acute infectious diseases of the respiratory system, central nervous system with the formation of purulent foci in various organs);
- pneumococcus (causative agent, etc.).
Penetration of an infectious agent into the epiglottis as a result of:
- trauma (if the mucous membrane of the laryngopharynx is damaged, for example, by a fish bone);
- burn.
Other predisposing factors:
- smoking;
- inhalation of irritating substances, polluted, dusty air;
- chronic foci of infection (carious teeth, chronic, etc.);

Diagnostics

Analysis of complaints and medical history: the patient complains of a sensation of a foreign body in the throat, severe pain in the throat, nasal voice, difficulty breathing, etc.
General examination: during examination of the head and neck, enlarged lymph nodes are determined, painful when palpated.
During laryngoscopy (a method of examining the larynx using a laryngeal mirror) or fibrolaryngoscopy (examination of the larynx using a flexible optical endoscope), in the initial stages, redness of the larynx is detected, the epiglottis is thickened and swollen. In the later period of development of the abscess, the swelling is not very pronounced, a spherical formation is present, the inflamed area is compacted, and a yellow spot may be present in the center of the area of inflammation - an accumulation of pus.

Treatment of epiglottis abscess

Treatment in a hospital setting.
It comes down to taking measures to promote the resorption of the infiltrate (dense area of inflammation) in the infiltrative stage or to emptying (opening) the abscess in the abscess stage. Medicines prescribed:
- intramuscular injections of antibiotics (antimicrobials) and anti-inflammatory drugs;
- painkillers.
If a formed abscess is present, then surgical cleaning of the purulent cavity is indicated. The abscess is opened through the mouth with a special laryngeal knife under local anesthesia.
In emergency cases, when severe swelling develops against the background of inflammation, the following is carried out:
- intubation (insertion of a breathing tube into the trachea through the mouth or nose);
- tracheostomy (insertion of a breathing tube into the trachea through an incision in the neck) - these measures must be resorted to extremely rarely in case of an epiglottis abscess.

Additionally

The epiglottis, or supraglottic cartilage, is an elastic cartilage in the form of a thin plate located immediately behind the root of the tongue. The functional significance of the epiglottis is to block the entrance to the larynx during the act of swallowing. The epiglottis prevents food from entering the airways during eating.