Epiglottitis is an inflammatory process in the epiglottis and tissues surrounding it, often leading to a sharp deterioration in the patency of the larynx. The acute form of the disease affects more often kids 2-4 years old, but both teenagers 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 frame that passes into the trachea and is lined from the inside with a mucous membrane, and the epiglottis is a mobile petal-like cartilage that acts as a kind of valve between the pharynx and trachea. It is he who prevents food boluses 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 the case of swelling of the epiglottis due to injury or inflammation, the tracheal inlet narrows until it is completely blocked.
The acute form of epiglottitis is diagnosed mainly in children of 2-4 years of age, howeverThe disease also occurs in adults. Due to the introduction of immunization (1985) against Haemophilus influenzae B-type, the disease occurs much less frequently.
Risk groups
The following categories of people are most likely to get epiglottitis:
- children with perinatal encephalopathy;
- males;
- patients at high risk of Hodgkin's disease;
- splenectomy patients;
- people with dark skin;
- people experiencing stressful situations with a subsequent significant decrease in the protective properties of the body;
- persons who stay for a long time among a large crowd of people (for example, school, supermarkets, and so on);
- 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 the nasal cavity in an inactive state, "waiting" for favorable conditions for its activation.
In addition, pathogens can be:
- candida (yeast-like fungi that cause thrush);
- A, C and B- streptococci;
- Varicella Zoster (cause of chickenpox);
- pneumococci ("causal" factor of meningitis);
- parainfluenza and herpes viruses.
Amongnon-infectious causes of epiglottitis matter:
- direct injuries;
- throat burns with hot liquids or chemical (alkali/acid) substances;
- foreign bodies that injure the respiratory tract;
- smoking;
- Using heroin/cocaine.
Pathogenesis
The basis for the development of epiglottitis is capillary ruptures, under the influence of respiratory viruses and, as a result, the occurrence of many small hemorrhages. Through the affected epithelium, bacterial pathogenic flora easily penetrates into the submucosal layer, causing inflammation and swelling of tissues. At the same time, the swollen epiglottis and the tissue surrounding it narrows the respiratory (larynx) tract, resulting in acute respiratory failure in severe cases and death of the patient.
Classification
There are several options for the course of epiglottitis, these are:
- acute (first-time occurrence);
- chronic (recurring episodes of illness).
In addition, the disease is usually divided into types:
- infiltrative;
- abscessing;
- edematous.
Clinical picture
In some cases, epiglottitis develops after infections localized in the upper respiratory tract.
The disease can progress at lightning speed, and 2-5 hours after the onset completely block the respiratory tract due to inflammation and severe swelling of the epiglottis.
The main symptoms of epiglottitis in children are:
- hyperthermia;
- anxiety;
- whooshing 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 his neck extended, his tongue hanging out and his mouth parted, the child's nostrils swell when trying to breathe in air.
If epiglottitis (see photo above) is provoked by Haemophilus influenzae, there is fever and severe soreness in the throat.
Other signs of illness:
- dysphonia;
- shortness of breath;
- drooling;
- cyanosis (cyanosis) of the lips due to lack of oxygen.
Edematous form
Accompanied by:
- hyperthermia (37-39 degrees);
- severe pain during swallowing movements;
- pronounced intoxication;
Palpation of the neck is very painful, and on examination the epiglottis mucosa is bright red. The lower segments of the larynx have no pathological changes.
Leukocytosis is usually determined in the blood, an increase in ESR.
Infiltrative and abscess forms
Accompanied by a serious condition of the patient, symptoms can grow both rapidly and slowly. The temperature rises to 39 degrees, patients complain of unbearable sore throats and lack of air. At the same time, a painful grimace freezes 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 a so-calledvitreous edema affecting the aryepiglottic folds and pyriform sinuses.
In acute epiglottitis, the exudative inflammatory component is combined with chondroperichondritis of the epiglottis. In the case of an acute abscessing form, pus is visible through the edematous mucosa, and the underlying parts of the larynx cannot be examined. The patient has severe inspiratory dyspnea.
Epiglottitis in children
Most often the disease affects boys 2-5 years of age. The "causal" factor in this case may be an ordinary tonsillitis or SARS.
Symptoms of epiglottitis in children develop at lightning speed (within a couple of hours). There is pain and shortness of breath, irritability, dysphagia, profuse salivation, fever and dysphonia. The baby 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. In this case, 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. At the same time, men are more susceptible to the disease, due to anatomical features and lifestyle (alcoholism, drug use).
The course of epiglottitis in adults and adolescents is subacute, that is, the symptoms (often a sore throat) increase over several days. Only 25% of these patientscomplain of shortness of breath, 15% of salivation and 10% have stridor.
Diagnostic measures
- Visual inspection. At the same time, it is possible to suspect the presence of epiglottitis in a child 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 detect the prevalence of edema and in the lateral projection - an increase in the epiglottis.
- Fibrolaryngoscopy. The only method by which the epiglottis in epiglottitis can be examined. This study is carried out exclusively in the operating room, where, if necessary, tracheal intubation can be performed. At the same time, the epiglottis is significantly enlarged in size and has a bright red tint.
- Blood test. There is bacteremia (25%).
- Crops from the pharynx. Haemophilus parainfluenca, Staphylococcus aureus, Streptococcus pneumoniae and pyogenes are found.
Pathology Therapy
Treatment of epiglottitis is carried out only in stationary conditions. Any treatment at home with the help of diets and folk remedies is not only ineffective, but also dangerous, as it leads to the death of the patient. Therefore, at the first signs of this pathology, an ambulance is called without delay.
The patient is transported exclusively in a sitting position. At the stage of transportation, the patency of the airways is restored, for this, the trachea is intubated, humidified oxygen inhalations, oxygen masks are used, or percutaneous puncture is performed.tracheostomy.
After arrival at the hospital, all of the above methods are used again and until the airway is completely restored.
After resuscitation, the ENT, together with the resuscitator, is prescribed
- antibacterial drugs from the penicillin and cephalosporin groups: Amoxiclav, Ceftazidime, Cefotaxime and others;
- sedatives;
- immunocorrective agents: "Likopid", "Bronchomunal", "Polyoxidonium";
- corticosteroid inhalation;
- infusion of saline solutions: "Lactasol", "Disol" and others;
- compresses using dimexide on the neck.
In the event of an infiltrative form of pathology, notches are made on the epiglottis (in the place of greatest swelling). In the case of an abscess on the epiglottis, it is opened.
Parents' actions
Having found manifestations of the disease in a child, you must immediately call an ambulance, before it arrives, you cannot put the baby to bed, or try to look into his mouth and press his tongue down. The only right thing to do in this situation is to remain calm and reassure the child.
Prevention
Specific preventive measures are reduced to vaccination. Moreover, a special vaccine has been developed for children under the age of five.
Adults with severely reducedimmunity and adolescents are also being vaccinated.
Non-specific prevention of the disease is to follow the following rules:
- hardening;
- not taking very hot food to avoid burns;
- frequent hand washing;
- correct, maximally balanced nutrition;
- immunity restoration;
- sports;
- eliminate bad habits (particularly smoking);
- avoid self-medication and seek medical attention early when the first signs of epiglottitis occur.
