What is epiglottitis?

- Epiglottitus is a potentially life-threatening condition that occurs when the epiglottis gets swollen. Now to really understand epiglottitus, you have to understand what the epiglottis is. So right over here, what I'm circling, this is the epiglottis. It's really just a little small lid that is protective of the airway. And I've got a couple different views right here so you can really see, you know... I'm not the best artist, so hopefully this rendition you can kind of understand what's going on here. But this is just a cross-section down the middle of the patient to really expose what the airway looks on the inside. So this would be the throat, right, this is the trachea down here. This would be the larynx, also known as the glottis. Also you may be more familiar with the vocal chords, that term. So these would be the vocal chords, and over the vocal chords is the epiglottis. And like I said, that just protects the airway. So when you eat food or swallow a substance- So for example, let's just do like, let's do a glass of water. Let's say water's going in, into the mouth. And so right here, I didn't highlight this before, but this is the tongue. Over here is the roof of the mouth, and here is your uvula, so that's just the little dangly thing in the back of the throat you see hanging down. So when water's coming through, right, you don't want water to get into the airway. Otherwise you'll start coughing and, you know, you could potentially have an infection and damage to the lung tissue if bacteria goes in with that water. So to be able to protect the airway, the epiglottis, whenever you swallow, this little flap goes down. So it'll kinda cover it up like that, kinda flip over. And so that protects the airway, protects the lungs from water or food or anything from getting into it. So you swallow and water will go down the right hole, down the esophagus. So that's really the concept of what the epiglottis does. It protects the airway. And so there's also this other sketch over here from a different angle that I wanna show you. Here again is the epiglottis. Here are the vocal chords right here, and you've got the- So here's the epiglottis, let's go ahead and circle that. And you've also got something called the aryepiglotic folds. And so these aryepiglotic folds are these little flaps on the side that connect the epiglottis down to this area over here. And the reason it's named the aryepiglotic folds is because it goes down to where the arytenoid cartilage is. And so these, what I'm circling right here, is the arytenoid cartilage. And I point this out because the arytenoid cartilage actually controls the vocal chords. So they actually control the closure of the vocal chords themselves to add extra protection for the airway. And here I have another sketch that I drew showing an overhead view. So this view right here is looking down at the vocal chords from this angle. And so you see up here is the epiglottis, right? Corresponds to over here. And down the side right here is the aryepiglotic folds, and you can see I kinda drew them a little bit in my picture, too, just going down. So I'm repeating all of this just so you can get a clear understanding of what the normal view of the epiglottis and the airway looks like. Because the issue with epiglottitus is this epiglottis can swell so much that it expands to block the airway. So whereas before it was just this tiny little flap, now it's swollen to enormous size, and it's actually closing off the ability for air to pass through into the trachea, or into the windpipe. Now you can imagine because of this, this is very severe. In fact, George Washington most likely actually died from complications of epiglottitus back in 1799. A really interesting kind of a little side note. Of course they didn't really have any cure for epiglottitus back then. Antibiotics weren't invented until the 20th century, but interestingly enough, one physician suggested that they could establish an airway by cutting into the skin through the cartilage, between the thyroid cartilage and the cricoid cartilage, to cut a hole into the airway to allow breathing. And of course, this is actually accepted nowadays as a treatment known as a cricothyroidotomy. Right, cricoid cartilage and thyroid cartilage. But this physician was actually scoffed at, and they didn't perform this life-saving procedure on the first President of the United States. So epiglottitus obviously can be very serious. And it's especially serious in children because they have a smaller airway. The diameter of their airway is already fairly narrow, so any additional swelling can cause this closure to be more prominent and more serious. So swelling of the epiglottis can actually give some very distinct symptoms. Obviously the patient will be experiencing a sore throat. They might also have a fever. A patient might also have a muffled voice because you know, they have difficulty speaking 'cause it's so sore, this epiglottis is so sore. So they might have what's called a hot potato voice, where they're leaning their throat forward and trying to talk without causing too much vibration to this area. That's called a hot potato voice, where it sounds very muffled. Patients do this to avoid causing pain to their throat. Now as before I said, patients may have difficulty swallowing, so that can actually lead to drooling. So you see pediatric patients will be drooling because, you know, they don't wanna swallow, so all this saliva just builds up. Another interesting symptom that can be seen is called a stridor. And what stridor is described as is kind of a musical sound on inspiration. So when a patient breathes in oxygen, which I'll do this light blue color, it is trying to get into the airway, and because the airway is narrowed, air kind of has this musical tune as it goes through. This is similar to trying to whistle. When you purse your lips, you narrow that airway and allow the wind to create a sound. So it actually sounds like, on inspiration, a patient has inspiratory stridor, it kind of sounds like a (inhaled gasp). They're trying to breathe (inhaled gasps). And it's because this airway's narrowed, and they can't get air into the lungs. Now of course, this is an emergency, and patients with epiglottitus should be brought to the emergency department right away. There should be really no delay 'cause the swelling can get worse and worse, and eventually close up the airway, leading to pulmonary arrest. So difficulty swallowing, along with drooling, maybe the stridor, you might start thinking of epiglottitus. And all of this can develop within a couple hours of a fever starting, so it can be very serious. And it should not be taken lightly.