Epiglottitis: Pathogenesis and clinical findings
Infectious cause: Bacterial (Staphylococcus aureus, Streptococcus pneumoniae, Neisseria
meningitidis, or most commonly Haemophilus influenzae in unimmunized children), viral or fungal
Authors: Alisha Ebrahim Reviewers: Simran Sandhu Mao Ding Michelle J. Chen Danielle Nelson* * MD at time of publication
Infectious agent invades the bloodstream and/or the epithelial layer of the epiglottis, aryepiglottic folds and adjacent structures, allowing for spread
Non-infectious cause: Ingestion of toxin or foreign body, thermal injury, or trauma
The potential space between the squamous epithelial layer and the epiglottal cartilage fills with inflammatory cells such as neutrophils and eosinophils
Exudate of inflammatory cells spreads through the lymphatic and blood vessels in the lingual surface of the epiglottis and periepiglottic tissues
Fluid and inflammatory cells accumulate between the squamous epithelial layer and epiglottal cartilage
Swelling of the entire supraglottic larynx
Tripod/sniffing position (Anxious- looking and sitting with trunk leaning
forward, neck hyper-extended and chin pushed forward to maximize airway diameter)
Stridor (High-pitched sound that is produced by obstruction in the larynx or just below)
Stertor (Low-pitched noise created in the nose or the back of the throat)
Retraction of the intercostal and suprasternal muscles
Tachypnea (Rapid breathing)
Increased weight and mass of the epiglottis Epiglottis curls posteriorly and inferiorly
Ball-valve effect (Airflow obstructed during inspiration as epiglottis is pulled over airway but not during expiration as epiglottis moves back into position)
↓ Diameter of upper airway
Epiglottis obstructs the esophagus
Dysphagia (Difficulty swallowing)
Cyanosis (Blue tint to skin)
Turbulent inspiratory airflow Aspiration of oropharyngeal secretions
Hypoxemia (Low oxygen levels in blood)
↓ Air entry to lungs
Airway obstruction
↑ Work of breathing
Drooling Pain when swallowing
Muffled/”hot potato” voice
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published Feb 5, 2024 on www.thecalgaryguide.com