Epiglottitis is an inflammatory process in the epiglottis and the tissues surrounding it, often leading to a sharp deterioration in laryngeal patency. Children of 2-4 years old suffer more often from an acute form of the disease, however, both adolescents and adults can get sick.
General information
For a better understanding of the disease process, it is necessary to understand the structure of the larynx. So, the larynx is a muscular-cartilaginous framework that passes into the trachea and is lined with mucous membranes from the inside, and the epiglottis is a mobile petal-like cartilage that serves as a kind of valve between the pharynx and trachea. It is he who prevents food lumps from entering the trachea.
When swallowing, the epiglottis covers the lumen of the trachea and food is sent to the esophagus. That is why it is impossible to swallow and breathe at the same time. If a person does not drink or eat, the epiglottis rises slightly, opening the opening of the trachea. In case of swelling of the epiglottis due to trauma or inflammation, the inlet of the trachea narrows to the point of complete closure.
The acute form of epiglottitis is diagnosed mainly in children 2-4 years of age, but the disease also occurs in adults. Thanks to the introduction of immunization (1985) from Haemophilus influenzae B-type disease occurs much less frequently.
Risk groups
The greatest likelihood of developing epiglottitis is present in the following categories of people:
- children with perinatal encephalopathy;
- males
- patients with a high probability of lymphogranulomatosis;
- patients undergoing splenectomy;
- people with dark skin;
- people experiencing stressful situations followed by a significant decrease in the protective properties of the body;
- Persons who have been in a large crowd for a long time (for example, schools, supermarkets, etc.);
- patients with individual intolerance to something.
Etiology of epiglottitis
The main "culprit" of epiglottitis is a special bacterium, Hemophilus influenza, B type. These microorganisms also cause meningitis and pneumonia. This microbe penetrates into the respiratory tract by airborne droplets, or is in an inactive state in the nasal cavity, "waiting" for conditions favorable for its activation.
In addition, pathogens can be:
- candida (yeast-like fungi that cause thrush);
- A, C and B - streptococci;
- Varicella Zoster (cause chickenpox);
- pneumococci (a "causal" factor of meningitis);
- parainfluenza and herpes viruses.
Among the non-infectious causes of epiglottitis are:
- direct injuries;
- burns of the throat with hot liquids or chemical (alkali / acid) substances;
- foreign bodies that injure the airways;
- smoking;
- heroin / cocaine use.
Pathogenesis
The basis for the development of epiglottitis is the rupture of capillaries, under the influence of respiratory viruses and, as a result, the occurrence of many small hemorrhages. Through the affected epithelium, the bacterial pathogenic flora, which causes inflammation and swelling of the tissues, easily penetrates into the submucosal layer. In this case, the swollen epiglottis and the surrounding tissue narrows the respiratory (larynx) pathways, as a result of which, in severe cases, acute respiratory failure occurs and the patient dies.
Classification
There are several options for the course of epiglottitis, these are:
- acute (occurring for the first time);
- chronic (recurring episodes of the disease).
In addition, the disease is usually divided into types:
- infiltrative;
- abscessed;
- hydropic.
Clinical picture
In some cases, epiglottitis develops after infections localized in the upper respiratory tract.
The disease can progress at lightning speed, and after 2-5 hours after the appearance, completely block the respiratory tract due to inflammation and severe edema of the epiglottis.
The main symptoms of epiglottitis in children are:
- hyperthermia;
- anxiety;
- wheezing noisy breathing;
- irritability;
- dysphagia;
- exhaustion;
- sore throat.
In order to alleviate their own condition, the children take a characteristic position: the baby sits, leaning forward with outstretched neck, protruding tongue and mouth open, the child’s nostrils swell when trying to breathe air.
If epiglottitis (photo above) is provoked by a hemophilic bacillus, fever and severe soreness in the throat are observed.
Other signs of illness:
- dysphonia;
- labored breathing;
- salivation;
- cyanosis (bluish tint) of the lips, due to a lack of oxygen.
Edematous form
Accompanied by:
- hyperthermia (37-39 degrees);
- severe soreness during swallowing movements;
- severe intoxication;
Palpation of the neck is very painful, and upon examination, the mucous membrane of the epiglottis is bright red. The downstream sections of the larynx have no pathological changes.
In the blood, leukocytosis, an increase in ESR, is usually determined.
Infiltrative and abscessed forms
Accompanied by a serious condition of the patient, the symptoms can increase both rapidly and slowly. The temperature rises to 39 degrees, patients complain of intolerable sore throats and lack of air. At the same time, a painful grimace sets on the patient's face.
The patient's tongue is covered with a dirty gray coating, and the epiglottis is hyperemic and significantly thickened, there is the so-called vitreous edema, affecting the scoop-palatine folds and pear-shaped sinuses.
In acute epiglottitis, the exudative inflammatory component is combined with chondroperichondritis of the epiglottis. In the case of an acute abscessed form, pus is visible through the edematous mucosa, and the underlying sections of the larynx cannot be examined. The patient has a pronounced dyspnea of the inspiratory type.
Epiglottitis in children
Most often, the disease affects boys 2-5 years of age. In this case, an ordinary sore throat or ARVI can become a "causal" factor.
Symptoms of epiglottitis in children develop at lightning speed (within a couple of hours). Pain and shortness of breath, irritability, dysphagia, profuse salivation, fever and dysphonia appear. The kid sits leaning forward, and saliva flows from his mouth.
The process progresses very quickly, within a few hours there is a complete obstruction of the airways. At the same time, children often die due to acute oxygen deficiency, inhalation of vomit and hypoxic coma.
Epiglottitis in adults and adolescents
In adulthood, the disease practically does not occur. In this case, due to the anatomical features and lifestyle (alcoholism, drug use), men are more susceptible to the disease.
The course of epiglottitis in adults and adolescents is subacute, that is, symptoms (usually sore throat) increase over several days. Only 25% of these patients complain of shortness of breath, 15% complain of salivation, and 10% have stridor.
Diagnostic measures
- Visual inspection In this case, the presence of epiglottitis in a child can be suspected by a characteristic posture: sitting with an inclination forward, an outstretched neck and a protruding tongue, as well as in examining the throat.
- X-ray examination, which allows to identify the prevalence of edema in the lateral projection - an increase in the epiglottis.
- Fibrolaryngoscopy. The only method by which the epiglottis with epiglottitis can be examined. This study is carried out exclusively in the operating room, where, if necessary, tracheal intubation can be performed. In this case, the epiglottis is significantly increased in size and has a bright red tint.
- Blood analysis. There is bacteremia (25%).
- Sowing from the throat. Haemophilus parainfluenca, Staphylococcus aureus, Streptococcus pneumoniae and pyogenes are found.
Pathology therapy
Epiglottitis treatment is carried out only in stationary conditions. Any treatment at home with the help of diets and folk remedies is not only not effective, but also dangerous, as it leads to the death of the patient. Therefore, at the first signs of this pathology, they immediately call an ambulance.
The patient is transported exclusively in a sitting position. At the stage of transportation, the airway is restored, the trachea is intubated, inhaled moistened oxygen, oxygen masks are used or puncture percutaneous tracheostomy is performed.
After arriving at the hospital, all of the above methods are used again and until the airway is completely restored.
After resuscitation, an ENT together with a resuscitator is prescribed
- antibacterial drugs from the penicillin and cephalosporin groups: Amoxiclav, Ceftazidime, Cefotaxime and others;
- sedatives;
- immunocorrection drugs: Likopid, Bronchomunal, Polyoxidonium;
- inhalation with corticosteroids;
- saline infusion: "Lactasol", "Disol" and others;
- compresses with dimexide on the neck.
In the event of an infiltrative form of pathology on the epiglottis (at the site of greatest swelling), incisions are made. In the case of an abscess on the epiglottis, an autopsy is performed.
Parent Actions
Having found a child’s manifestations of the disease, you need to immediately call an ambulance, until her arrival you can not put the baby, or try to look into his mouth and press down his tongue. The only right thing in this situation is to keep calm and calm the child.
Prevention
Specific preventive measures come down to vaccination. Moreover, for children under the age of five, a special vaccine has been developed.
Adults with significantly reduced immunity and teens are also vaccinated.
Nonspecific prevention of the disease consists in observing the following rules:
- hardening;
- intake of not very hot food in order to avoid the occurrence of a burn;
- frequent hand washing;
- proper, most balanced nutrition;
- restoration of immunity;
- playing sports;
- the eradication of bad habits (in particular smoking);
- the exclusion of self-medication and early treatment for medical help when the first signs of epiglottitis occur.