Epiglottitis - What is it?

Definition

Epiglottitis is usually a bacterial infection of the lining that is confined to the larynx. This means that it can be found in the area between the throat and the windpipe. Typically it manifests itself as a rapid onset of fever with a sore throat. A wheezing sound during inhalation and lumpy speech may also occur as the infection progresses. There is always a need for medical attention with this disease, since in the worst case it can lead to an obstruction of the airways.

causes

The cause of epiglottitis is usually a bacterial infection of the mucous membrane. To be precise, it is the pathogen called "Haemophilus influenzae Type B" that triggers this clinical picture. It is transmitted via droplet infection.

Nowadays infections with this bacterium are rather rare, as there is a protective vaccination for prevention. Vaccinated children no longer develop epiglottitis when they come into contact with the bacteria, or they only develop mild symptoms. However, if an illness does occur, it affects adults more often. Decreasing vaccination protection is discussed over the years. The pathogens then prefer to settle in the area of the larynx and lead to inflammation.

In contrast to children, however, other bacteria such as streptococci can also be the cause of the disease. A calculated therapy and possibly a pathogen detection through a smear is required here.Viral pathogens are only very rarely considered in inflammation of the epiglottis and do not cause the typical symptoms. Purely mechanical or thermal irritation of the epiglottis is very atypical. Drinking too hot beverages or damaging the epiglottis with food components cannot usually be suspected as the cause of epiglottitis. From an anatomical point of view, it is too deep. Liquids or drinks would therefore tend to irritate structures higher up, such as the pharynx or the tonsils.

diagnosis

The diagnosis of epiglottitis in adults is made in the majority of cases by an ENT specialist. However, a family doctor is also able to diagnose inflammation of the epiglottis, but may include a specialist in the treatment. The pediatrician is responsible for children. All doctors make their diagnosis by looking at the epiglottis in conjunction with the symptoms of the person affected. In addition to a detailed survey, the epiglottis is therefore always inspected through the mouth using a small mirror.

What are accompanying symptoms?

The inflammation of the epiglottis manifests itself primarily in a more or less severe sore throat. This is due to the local swelling of the mucous membrane, which leads to excessive tension on the surface. If the mucous membrane comes into contact with the mucous membrane of the surrounding throat during the act of swallowing, this leads to a painful sensation due to further pressure on the tissue. The further the swelling progresses, the more it affects the language. In the case of those affected, this is expressed in lumpy language. No hoarseness is to be expected as the vocal folds are not affected by the infection.

Additional symptoms can include increased salivation and breathing sounds during inspiration (inhalation). The flow of saliva can be explained by the local irritation of the mucous membrane. Salivary glands in the throat area are reactively sensitized and produce more secretions. Those affected therefore have the feeling that they have to swallow more often. The breathing noise is in turn caused by the narrowing of the airway. It can vary from a whistle to a hiss. The perception of a breath sound is an indication of the danger of the swelling. At this point at the latest, those affected should seek medical advice. Depending on the general condition of the patient, an increased temperature or even fever often occurs. It is justified by the reaction of the immune system to the pathogen.

Treatment and therapy

In the case of epiglottitis, the therapy depends on the severity of the symptoms. As a cornerstone of therapy, however, the attending physician will always prescribe an antibiotic. This is due to the concern that if the infection progresses, the airways will be blocked. If there are only mild symptoms in addition to the inflammation, purely symptomatic therapy with additional antipyretic and pain reliever drugs is sufficient.

However, if there is a pronounced breathing noise or even difficult breathing, inpatient treatment in the hospital is indicated. In children in particular, the risk of airway constriction is very high, as the diameter of their airways is simply smaller. Here a swelling quickly means the development of shortness of breath. Depending on the severity of the swelling, even short-term ventilation may be indicated in order to keep the airways free. In such drastic course of the disease, glucocorticoids such as cortisone are also given to control the symptoms. In most cases, however, the timely administration of antibiotics and close observation of the person concerned is sufficient.

Duration of epiglottitis

The duration of epiglottitis should not last longer than about ten days with adequate therapy. Adults need a slightly longer recovery time compared to children. In children, a significant improvement can usually be observed after about three days. However, whether the healing takes a day longer or shorter is not decisive. It is only important that the tendency always goes towards regression of the symptoms. A worsening of the symptoms should be an immediate reason to go to the doctor again.

Difference between adults and babies

The biggest difference in epiglottis between adults and babies is the size of the airways. The diameter mainly determines the possible complications and determines the period of action for a successful therapy. The smaller the lumen of the airways, the faster the swelling of the mucous membrane leads to obstruction. The result can be difficult breathing or even shortness of breath. In adults, this lumen is comparatively large and normally gives those affected enough time to recognize the symptoms independently and classify them as dangerous. A baby neither has the competence to report in time, nor to report his problem. Here it depends on a good observation of the parents to recognize the time of treatment. In addition, the therapy must then start quickly and more radically than in adults in order to avoid a worsening of the condition.

But it's not just the complications and their development over time that make the difference in epiglottitis between adults and babies. The pathogens can also be of different nature. In babies, it is almost exclusively bacteria that lead to epiglottitis. To be precise, it is “Haemophilus influenzae type B”. In adults, however, other bacteria, such as streptococci, can also trigger the infection. In very rare cases viruses are even possible triggers. Thus, in adults, a broader spectrum of pathogens comes into consideration and may require specific further diagnostics. However, if complications arise in the event of illness, they are treated in the same way as with the child. However, they are much rarer as most adults have adequate vaccination protection.

How contagious is epiglottitis?

In itself, epiglottitis is very contagious. Your pathogens are transmitted via droplet infection. Those affected usually suffer from a severe sore throat and often clear their throat, so that the pathogen is relatively likely to escape through the oral cavity.

The good news, however, is that very many in Germany are vaccinated against the typical pathogen of epiglottitis and are therefore immune. Infection is very unlikely in these cases. Contact with the patient is therefore usually harmless. Nevertheless, the disease requires physical rest, so those affected should stay at home. And finally there is the risk of other pathogens as the cause of the disease, so social contact should be avoided for the time being.

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