Acute Epiglottitis
(Syn. Supraglottic Laryngitis)
(Syn. Supraglottic Laryngitis)
Definition: An acute inflammatory condition confined to supraglottic structures (Epiglottis, Aryepiglottic folds, Arytenoids). It causes marked oedema which may obstruct the airway.
Aetiology
- Severity: Serious condition.
- Age Group: Typically children 2–7 years (can affect adults).
- Organism: H. influenzae B (Most common in children).
Clinical Features
Onset: Abrupt with rapid progression. Fever may reach 40°C (due to septicaemia).
| Patient Group | Common Presenting Symptoms |
|---|---|
| Children | Dyspnoea & Stridor (Rapidly progressive; fatal unless relieved) |
| Adults | Sore throat & Dysphagia |
Examination & Diagnosis
1. Physical Signs
- Red and swollen epiglottis.
- Indirect laryngoscopy: Oedema and congestion of supraglottic structures.
⚠ CRITICAL ALERT:
Avoid depressing the tongue or performing indirect laryngoscopy in the ward. It may precipitate complete airway obstruction. Examination should be done in the Operation Theatre where intubation facilities are available.
Avoid depressing the tongue or performing indirect laryngoscopy in the ward. It may precipitate complete airway obstruction. Examination should be done in the Operation Theatre where intubation facilities are available.
2. Imaging
Lateral Soft Tissue X-ray (Neck): Shows swollen epiglottis.
"Thumb Sign"
Treatment
- Hospitalisation: Essential (due to danger of respiratory obstruction).
- Antibiotics: Ampicillin or 3rd Gen Cephalosporin (IV/IM). Start immediately without waiting for culture.
- Steroids: Hydrocortisone or Dexamethasone (IV/IM) to relieve oedema and avoid tracheostomy.
- Hydration: Parenteral fluids.
- Supportive: Humidification (mist tent/croupette) and Oxygen.
- Airway: Intubation or Tracheostomy if obstruction occurs.
📚 Source: ENT Dhingra
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