URTObstruction - Diseases
Introduction Physical Examination Differential Diagnosis Specific Diseases Epiglottitis Clinical Diagnosis Airway management Supportive therapy Viral croup Foreign body aspiration Retropharyngeal abscess References Other Lectures		Epiglottitis is a life-threatening disease - a true pediatric emergency. However, since 1988, when Hib conjugate vaccines were introduced first in toddlers and then 2 years later in infants, the incidence of invasive Hib disease in infants and young children has decreased by 99% to fewer than 1 case per 100,000 children younger than 5 years of age. Coincident with this decline in invasive Hib disease, the natural history and epidemiology have changed. The age range in the pre-vaccine era was 2 to 7 years old. Currently, the mean age of children with epiglottitis is 11-14 years. Interestingly, the majority of these patients have been previously immunized against Hib. While Hemophilus influenzae remains the dominant pathogen, other gram-negatives as well as gram-positive cocci are often recovered. Classically there is an abrupt onset over several hours of high fever, sore throat, stridor, dysphagia and drooling. The parent often can tell you the exact time of day the child became ill. Physical exam reveals a toxic-looking child with an ashen-gray color, very apprehensive and anxious looking, but with minimal movements. There is usually quiet breathing with little air exchange, no hoarseness, but a whispering voice. The characteristic position is sitting up with chin forward and neck slightly extended - the so-called sniffing position. Absence of a spontaneous cough can be a key historical point differentiating epiglottitis from viral croup. Epiglottitis can also occur in teenagers and young adults, presenting with sore throat, fever and drooling over several days, not hours. Stridor occurs less often in adults than children. Epiglottitis should be considered at this age if the symptoms of severe sore throat, dysphagia and drooling are out of proportion to the visible pharyngeal pathology. Often there is significant tenderness with gentle movement of the hyoid. Although H. influenzae is still the most common organism, other gram-negatives, as well as gram-positive cocci are also common at this age. There are reports of rapid-onset URT obstruction due to traumatic epiglottitis, secondary to blind vigorous attempts, usually by the parents at home, at removal of a foreign body from the child's throat. Return to top of page