Curriculum · ENT, Ophthalmology, and Dermatology
Acute epiglottitis
What it is
Acute epiglottitis is inflammation of the epiglottis and the supraglottic structures. It is seen primarily in children, and adults may be affected too. The age given for it differs between pages: one gives 2 to 7 years, another 3 to 7 years, and a third ties it to the 3 to 6 year group. Epiglottitis is one of the acute and sub-acute causes of stridor, which is a monophonic, high-pitched inspiratory sound caused by narrowing of the upper or central airway.
Causes and risk
The cause given is Haemophilus influenzae type B. It is now less common because of vaccination.
How it presents
The onset is sudden, over minutes to hours, with no preceding coryza. There is high fever, given as above 38.5°C on one page and as more than 38.6 on another, with severe sore throat and a toxic, very ill appearance. The child sits in the tripod position, drools saliva and is not able to drink. Stridor is present at rest, and it is soft and whispering; the voice and cry are muffled, with reluctance to speak. Cough is absent or slight. Other findings named on the picture are bluish lips and retractions. The features are grouped as the 4 Ds, and the two pages that give them do not give the same four: one lists dyspnea, dysphagia, drooling and dysphonia, the other lists drooling, dysphagia, dysphonia or stridor, and distress. A second mnemonic is the story of 3 DOGS: drooling of saliva, thumbprint sign on the lateral neck x ray from thickening of the epiglottis, and the sniffing dog position. The dogs do not bark, and a barking cough is not seen in epiglottitis. The 3 stands for the tripod position, the 3 to 6 year age group, and the 3rd generation cephalosporin as the drug of choice. The contrast with croup is direct. Croup comes on over days, given elsewhere as 1 to 3 days, follows coryza, gives a severe barking cough with no drooling, allows the child to lie down, gives stridor when upset, keeps the fever below 38.5°C, makes the voice hoarse and the stridor harsh and rasping, and shows the steeple sign rather than the thumb sign.