Epiglottitis is the infection and inflammation of the epiglottis. Although initial symptoms are mild, the disease can worsen rapidly and if left untreated may be life-threatening.

Who is affected by the condition?

The condition is most common among children between aged 2 and 7. With advent of mass vaccination against Haemophilis influenza type b (that is the leading cause of the condition), the incidence has reduced to a great extent.

Symptoms of epiglottitis

Symptoms of epiglottitis include (1-6):

• Sore throat seen in most cases
• Difficulty in swallowing also seen in most cases
• High fever often reaching 40 degree Celsius in children and difficulty in breathing.
• Breathing may be accompanied by grunts. There may be a mild cough, irritability and a generally sick appearance of the patient.
• Muffling or hoarseness of voice is seen in nearly 50% cases. This is often termed “hot potato” voice. It appears as if the patient is struggling to speak with a mouthful of hot food.
• Excessive drooling of saliva due to inability and pain on swallowing. Drooling occurs in up to 80% of children with epiglottitis.
• Typical position called the tripod position. The patient prefers to sit up on his or her hands with head leaning slightly forward and tongue sticking out. This position is preferred because it allows maximum air entry into the lungs.

  A child with suspected epiglottitis should not be laid on his or her back. Parents are advised not to put anything inside the child’s mouth. This could lead to closure of the airway and immediate death.

• There is severe pain when the front of the neck is examined by touching.
• With advanced cases there may be severe obstruction in breathing leading to stridor. This is a specific noisy breathing that indicates advancing blockade of airways. This may be life-threatening.
• As there are progressive airways obstruction there is lack of oxygen in blood manifested as bluish or greying of skin. This is called cyanosis and is a warning sign and usually signifies that the patient is worsening progressively and rapidly. Immediate opening of airways is necessary.
• Adults tend to have less severe symptoms than children and the symptoms tend to develop more slowly. In children worsening may occur very rapidly.
• Swollen lymph nodes or lymphadenopathy at the neck as an indication of infection.

The four classic symptoms of epiglottitis

Thus, to summarize, classic four symptoms define the diagnosis of epiglottitis. These include the four D’s –

• Drooling of saliva due to inability and pain on swallowing
• Dyspnea – Shortness of breath or difficulty in breathing
• Dysphonia – Hoarseness of voice
• Dysphagia – Difficulty in swallowing