Epiglottitis

Learning objectives

Epiglottitis is a life-threatening inflammatory condition that causes swelling of the upper airways which can lead to asphyxia and respiratory arrest
Usually caused by infection
Noninfectious causes: Trauma from foreign objects, inhalation, and chemical burns
Affects the epiglottis and nearby structures (arytenoids, aryepiglottic folds, vallecula)
Symptoms can be exacerbated by patient discomfort or agitation

The airway in the pediatric population differs from adults
The epiglottis is located more superiorly and anteriorly
More oblique angle with the trachea
The narrowest part of the pediatric airway is the subglottis, in contrast to the glottis in adults
The infant epiglottis is comprised of cartilage and far more pliant
Infectious processes that lead to edema and mass increase of the epiglottis are more likely to cause symptoms in children
Each inspiration pulls the edematous epiglottis over the laryngeal airway, causing symptoms

Oropharyngeal exam may lead to loss of airway
Lateral neck radiograph: Swelling of the epiglottis (only perform in stable, cooperative patients)
When epiglottitis is suspected, transfer the patient to the operating room for airway assessment
Differential diagnosis: laryngotracheobronchitis (croup), airway obstruction from a foreign object, acute angioedema, caustic ingestion, diphtheria, peritonsillar/retropharyngeal abscess