• Life-threatening, medical emergency due to infection with edema of epiglottis and aryepiglottic folds

• Introduction of Haemophilus influenzae type B vaccine in 1985 has led to marked decrease in number of cases of epiglottitis
• Still remains the most common cause
• Also caused by
• Pneumococcus
• Streptococcus group A
• May also be caused by thermal injury

• Typically between 3-7 years
• Peak incidence has become older over last decade and is now closer to 6-7 years

• Classical triad is: drooling, dysphagia and distress (respiratory)
• Abrupt onset of respiratory distress with inspiratory stridor
• Sore throat
• Severe dysphagia
• Older child may have neck extended and appear to be sniffing due to air hunger
• Resembles croup clinically, but think of epiglottitis if:
• Child can not breathe unless sitting up
• “Croup” appears to be worsening
• Child can not swallow saliva and drools (80%)
• Cough is unusual

• Purely supraglottic lesion
• Associated subglottic edema in 25%
• Associated swelling of aryepiglottic folds causes stridor

• Patient needs to be accompanied everywhere by a physician experienced in endotracheal intubation
• Imaging studies are not always necessary for the diagnosis
• Lateral radiograph should be taken in the erect position only, as
• Supine position may close off airway
• Enlargement of epiglottis
• “Larger than your thumb”
• Thickening of aryepiglottic folds
• True cause of stridor
• Circumferential narrowing of subglottic portion of trachea during inspiration
• Ballooning of hypopharynx and pyriform sinuses
• Reversal of the normal lordotic curve of the cervical spine

• Danger of suffocation secondary to complete airway closure

Epiglottitis. Lateral radiograph of the neck demonstrates and enlarged epiglottis (red arrow) and thickening of the aryepiglottic folds (yellow arrow). There is also reversal of the normal lordotic curve in the cervical spine and slight dilatation of the hypopharynx.