Epiglottitis: Symptoms and Treatment of Laryngeal Inflammation? Why does it endanger children?

Epiglottitis, more precisely acute epiglottitis or even acute laryngeal inflammation, is a life-threatening disease. It has a sudden course, it develops from full health within a few hours.

However, progression and deterioration can occur in minutes.

It is said to mainly affect children under the age of 6-7 years. On average, these are children aged 3 to 4.

Boys have a higher susceptibility to the disease.

It has no relation to seasonality, as is the case with laryngitis.

The basis for the outbreak is bacteria with primacy  Haemophilus influenzae B. Following the introduction of vaccination against hemophilic infections, inflammation of the laryngeal flap occurs less frequently.

In adults, other bacteria are involved in the disease. An injury to the flap can also be the cause.

What is a laryngeal valve in short

It is technically referred to as epiglottis. It is placed behind the root of the tongue at the point of departure of the larynx from the pharynx. It resembles a leaf in shape and is formed by elastic cartilage.

The main function of the flap ...

When swallowed, it covers the entrance to the larynx - larynx, which prevents food and fluids from entering the airways.

Prevents aspiration.

Why is epiglottitis dangerous?

Epiglottitis is a phlegmonous inflammation of the laryngeal flap. Inflammation forms during inflammation.

The swelling causes partial or complete closure of the airways at the site of the epiglottis. With partial closure, respiration is significantly worsened, with full closure it is impossible.

The laryngeal entrance is covered by an enlarged flap, which forms a mechanical barrier - it prevents the passage of air into the lower respiratory tract and lungs.

Childhood is a risk factor. The reason is the anatomical ratio in the airways of children. Smaller space and swelling cause more significant breathing difficulties.

The second reason is the state of immunity. In childhood, the ability to produce IgG 2 antibodies, which have specific properties in the immune response, is reduced.

What is a hemophilic infection?

Haemophillus influenzae serotype A to F - subtype B is the most dangerous.

Hemophilic infections are widespread among humans worldwide. It is therefore an exclusively human disease. They are spread by droplet infection, from person to person, coughing, sneezing, but also by direct contact (in children's groups through toys). The entrance gate is mainly the mouth and nose.

In most cases, they occur mostly in children under 5 years of age, due to the immaturity of the defense - immune system - at the level of immunoglobulin IgG 2.

The most common cause of the disease is  Haemophilus influenzae type B - abbreviation Hib. Its danger lies in the fact that it is the cause of various diseases.

Bacteria enter the mucous membranes of the oral cavity, nose or larynx, and pharynx. Subsequently, they can travel through the bloodstream throughout the body.

What diseases occur in hemophilic infection :

• meningitis - Meningitis
• pneumonia - pneumonia
• laryngitis - epiglottitis
• otitis media
• sinusitis
• inflammation of the joints - arthritis
• bone marrow inflammation - osteomyelitis

Prior to the introduction of vaccination, it was the most common cause of purulent meningitis - purulent meningitis - in children under 5 years of age.

Following vaccination, the incidence of type B hemophilic infections decreased.

Although epiglottitis is not a common disease nowadays, it is dangerous.

It is caused by bacteria. It is therefore of Haemophilus influenzae infection Haemophilus B subtype.

The cause of the danger is phlegmonous inflammation in the area of ​​the laryngeal flap. Inflammation results in swelling, enlargement of the duct, and reduction to complete restriction of the space for air passage to the lower respiratory tract, and thus also to the lungs.

As a result, there is significantly impaired breathing and suffocation and the inability to inhale.

Bacteria causing epiglottitis:

• Haemophilus influenza B has the upper hand
• Staphylococcus aureus
• Streptococcus agalactiae
• Staphylococcus pyogenes
• Streptococcus pneumonia
• Moraxella catarrhalis

The non-infectious cause is an injury to the flap. A good example is burning a hatch with hot food or drink.

Other types of bacteria or the mechanism of injury is the cause of problems with the pill in adulthood.

 The peculiarity of childhood with respect to breathing

Childhood gives this period various peculiarities. For this reason, too, a child cannot be considered a small adult.

From newborns to about 12 years of age.

Peculiarities of children as stated by Viliam Dobiáš and the team in the book Pre-hospital emergency medicine:

• larger head and shorter neck
• nasal breathing, especially in newborns and infants - rhinitis, swelling of the nasal cavity are a problem
• saliva  is produced to a greater extent, the risk of aspiration in unconscious children
• the tongue is larger in relation to the oral cavity
• larynx - larynx is in a higher position and in front
  • in children, the subglottic area is the narrowest place
• the laryngeal flap is longer, softer in the shape of the letter U
• trachea - trachea is shorter - the risk of unilateral intubation 
• bronchi receding at approximately the same angle, possible transmission of respiratory phenomena during unilateral intubation - difficult control
• the mucous membrane of the respiratory tract is more sensitive and swells rapidly
• higher risk of laryngospasm - laryngeal contraction
• respiratory exertion in younger children is more exhausting
• the need for oxygen is relatively higher in childhood
  • therefore, children have a faster respiratory rate
  • slowed breathing leads more quickly to hypoxia - insufficient oxygenation of tissues and organs

For these reasons, it is necessary to pay the utmost attention to children's difficult breathing.

Symptoms develop quickly within a few hours. It is stated that this can happen within 12 hours. However, escalation to serious health hazards can occur suddenly, even within minutes.

Symptoms of upper airway inflammation are also present. Examples are fatigue, general weakness.

The diseases present a high fever, that is body temperature of 38 ° C. The temperature rises to 40 degrees Celsius.

Sore throat, which can have a cut character,  is of marked intensity. An already high degree of pain worsens swallowing.

Painful swallowing is also technically referred to as odynophagia.

The result is a typical saliva leak from the mouth.

Severe pain is the reason why a child is afraid to talk or cough. Alternatively, the cough is only superficial - careful.

He refuses to drink fluids. He has an open mouth or a protruding tongue. An inflamed and swollen laryngeal flap also makes it impossible to drink fluids or swallow saliva.

The child is remarkably calm but frightened. Pale. The so-called toxic appearance is mentioned - the impression of a seriously ill person.

Crying, speaking, moving and lying down would make breathing difficult.

Several signs draw attention to respiratory distress. And this is, for example, the sitting position when the child refuses to lie down. Even the supine position makes breathing worse.

The child is bent forward, has a bowed head and an ajar mouth. He gasps for air. In difficulty breathing, he can help by supporting his hands.

Saliva flows from his mouth. This is a characteristic manifestation of epiglottitis. 

This position is also referred to as position čuchajúceho dog - sniffing dog (English).

In infancy, young children bow their heads conspicuously, trying to relax their airways.

In epiglottitis, the so-called trias is reported, ie the presence of three symptoms :

1. dysphagia - a swallowing disorder
2. dysphonia - a voice disorder
3. dyspnoea - a breathing disorder

In the case of this disease, there is a quieter wheezing - inspirational stridor, which is rather moist and bubbling. In case of a more severe condition, whistling is also during exhalation - expiratory stridor.

The severity of the situation is exacerbated by the symptom of silent lungs - during an auscultation examination. Expert examination by a doctor with the help of a stethoscope.

Lack of oxygen in the tissues, ie hypoxia, also means fatigue, loss of interest in the environment, apathy, and even confusion.

Complete airway closure leads to suffocation and death.
Up to 25% mortality is reported for this disease. 
Therefore, prompt detection, diagnosis and early treatment are important. 

Diagnosis is performed mainly with the help of anamnesis and clinical picture. Physical examination and the presence of these symptoms lead to an accurate diagnosis.

The visual examination must be performed with caution. An enlarged, reddish, and leaky laryngeal flap can be seen with a wooden wooden shovel after a slight pressure of the tongue. It can have different shapes.

This examination is in the hands of a doctor. Careless handling can worsen the course and situation.

A child with this disease belongs to professional care. Hospitalization is required.

Alternatively, laryngoscopy may be supplemented by an ENT specialist. However, there is a risk of respiratory tract irritation and laryngospasm, ie laryngeal contraction. 

Other methods are X-ray, CT. CRP and laboratory blood and urine tests may be added at a later date.

Choking, and thus airway obstruction, restriction of air passage - can be caused in childhood by another cause:

• laryngitis
• inhalation of a foreign body
• asthma
• bronchiolitis - inflammation of the trachea
  • other inflammations include peritonsillar or retropharyngeal abscess

Interesting information in the articles: 
Laryngitis
Sore throat

The table shows the basic differences in laryngitis and epiglottitis

The course of the disease is sudden. Although the first symptoms are mild to inconspicuous, the acute disease progresses rapidly.

Non-specific symptoms of upper respiratory tract inflammation may be present. There is a significant sore throat, which is complicated by difficult and painful swallowing. Body temperature rises, often up to 40 ° C. The child refuses to drink.

A typical picture of the disease develops.

Difficulty breathing comes to the fore. This forces the child to sit up. His mouth is parted, saliva is flowing out of it. He is leaning forward, he can lean on the mat with his hands and he puts his head in a mild law.

Reminiscent of the position of a sniffing dog.

His face is frightened, too quiet. Pale. When obstruction can board cyanosis - blue lips or fingers skin.

She is very tired and even apathetic. There is a risk of airway obstruction and suffocation.

Therefore, professional examination and early treatment are necessary. It is recommended to call 155 for a fast progress.