Protection of the airway is a priority, and treatment may require placement of an artificial airway, intravenous steroids, antimicrobial therapy to control infection, and surveillance in an intensive care unit. Tracheostomy may be required in severe cases if airway management is not achievable with medical intervention or oral / nasal intubation.
The prevalence of severe epiglottitis in children has been reduced substantially in the United States and other developed countries since Hib vaccination has become a standard of care. Prior to routine immunization, the incidence of epiglottitis was approximately 5 per 100 000 children. Current estimates have the incidence at about 0.6-0.8 per 100 000 children. The incidence in adults has remained stable (0.6-1.9 per 100 000 people). Prognosis has improved, particularly when intervention is prompt, with recognition of the potentially severe airway compromise.
The leading cause of epiglottitis in children is bacterial infection. Hib remains a leading causal organism but has a markedly decreased incidence. Group A Streptococcus, Staphylococcus aureus, and H influenza types A and F, and nontypeable H influenza, in addition to viral and fungal infections, have all been associated with epiglottitis.
Since widespread immunization against Hib, the average age of epiglottitis in children has increased. Nonimmunized populations and immunocompromised individuals are at increased risk for epiglottitis.
Epiglottitis in adults is also primarily attributed to infection but from different organisms. Streptococcus pneumoniae is the leading infectious agent, with other viral, bacterial, and fungal sources described as causal agents.
In both pediatric and adult patients, trauma from burns, caustic injuries, or foreign body ingestions are potential noninfectious etiologies of epiglottitis.
J05.10 – Acute epiglottitis without obstruction
80384002 – Epiglottitis
Differential Diagnosis & Pitfalls
- Laryngeal neoplasm / cancer
- Laryngeal cyst
- Laryngeal polyp
- Laryngeal papilloma
- Spasmodic cough
- Subglottic stenosis
- Oropharyngeal neoplasm
- Severe tonsillitis
- Bacterial tracheitis
- Retropharyngeal abscess
- Peritonsillar abscess
- Esophageal rupture / perforation (see spontaneous rupture of esophagus)
- Laryngeal foreign body (see foreign body aspiration)