Acute epiglottitis is an acute inflammation characterized by supraglottic epiglottitis. Many diseases have sudden onset and rapid development, which are easy to cause upper respiratory tract obstruction. The main manifestations are epiglottis and aryepiglottis with acute edema and cellulitis, which can further form epiglottis abscess. Because the venous blood of epiglottis flows through the epiglottis root, if the epiglottis root is oppressed by inflammatory infiltration and venous reflux is blocked, epiglottis will quickly appear severe edema and will not fade easily. Inflammation involving vocal cords is rare. Both adults and children can get sick, and the number of adult patients has increased in recent years. It can happen all year round, especially in early spring and late autumn. There are more male patients than female patients.

(1) etiology

1. infection is a common cause of this disease. The most common bacterium is Haemophilus influenzae, and the detection rate of this bacterium is high in severe patients. In addition, staphylococcus, streptococcus, pneumococcus, Neisseria catarrhalis, diphtheria-like bacilli, etc. , can also be mixed with viruses.

2. Allergy Systemic allergy can also cause epiglottis, epiglottis is highly edema, and secondary infection can occur.

3. Trauma, foreign body trauma, irritating harmful gases, irritating drinks and food, radiation injury, etc. can cause inflammatory lesions of epiglottis mucosa.

4. Acute inflammation of adjacent organs, such as acute tonsillitis, pharyngitis, stomatitis, rhinitis, etc., spreads and invades epiglottis, and can also be secondary to acute infectious diseases.

5. Epiglottic cyst or secondary infection of new organisms can also cause this disease.

(2) Diagnostic points

1. History: history of infection, history of allergic diseases, trauma and acute inflammation of adjacent organs.

2. Symptoms: the onset is sudden, and the medical history rarely exceeds 6 ~ 12 hours. Most patients fall asleep in a normal way and wake up in the middle of the night with sudden sore throat or airway obstruction. Their condition develops very rapidly. The main symptoms are systemic poisoning, dysphagia and dyspnea. For young children, this is often very critical.

(1) Severe systemic symptoms include chills, high fever, general malaise, loss of appetite and general pain, which can lead to rapid failure in children.

(2) Dysphagia occurs quickly. In severe cases, people drink water and cough, and their mouths drool; The lighter person feels that there is a foreign body in the pharynx, and it is difficult to open his mouth occasionally.

(3) Dyspnea is mainly inspiratory dyspnea, accompanied by inspiratory hyperventilation and expiratory snoring. In children and adults, fulminant patients develop rapidly and can quickly lead to suffocation. Because vocal cords are often unaffected, they are generally silent or only blurred.

(4) Sore throat Except for infants who can't complain of pain, most patients have sore throat, which is aggravated when swallowing. However, the color of pharyngeal mucosa is still normal, so we should pay attention to it.

3. Examination results: The patient is in critical condition and often has difficulty breathing.

(1) Pharyngeal examination: there is no obvious lesion in pharyngeal mucosa. Children with high epiglottis can sometimes see that the epiglottis is very red and swollen as long as they press the tongue base with a tongue depressor. Don't force your tongue too hard or too hard, so as not to cause vagal reflex and sudden death.

(2) Indirect laryngoscopy in adults and older children showed hyperemia and swelling of epiglottis mucosa (especially on the tongue surface), and edema was spherical, mostly on one side. Sometimes a small horn nodule, aryepiglottic fold, epiglottic valley or oropharynx will also be involved. Occasionally accompanied by ulcers. If epiglottic abscess has formed, you will see local uplift with yellow pus spots, pus heads or a small amount of pus leakage. Inflammation involving epiglottis and larynx is rare, and once it is involved, dyspnea is more serious. The vocal cords and subglottic areas are difficult to see because the epiglottis cannot be lifted.

(3) It is difficult for children to cooperate with indirect laryngoscopy, and sometimes direct laryngoscopy is needed. Generally, you can see epiglottis by lifting the base of your tongue. Pay attention to sputum aspiration and keep the respiratory tract unobstructed to prevent accidents.

(4) One or both deep cervical lymph nodes are swollen with tenderness. Sometimes there is tenderness in one or both hyoid angles, the outer edge of thyroid cartilage plate and mandibular angle. The neck occasionally swells.

(5) Laboratory examination showed that the total number of white blood cells increased, often in the range of 1.0 ~ 2.5× 1.09/L, neutrophils increased and the nuclei shifted to the left. Acute allergic epiglottitis is as follows: eosinophils in peripheral blood or epiglottis secretion smear increased to 3% ~ 7%, and other blood cells were normal; Most allergen intradermal tests were positive.

(6) Imaging examination If necessary, imaging examination and throat X-ray examination are feasible, which are valuable for the diagnosis of acute epiglottitis. Swelling epiglottis can be seen on the lateral radiograph, and the shadow of laryngopharyngeal cavity is narrowed and the boundary is clear. However, if the clinical diagnosis has been made clearly, this examination should be omitted, because it will inevitably delay the opportunity of treatment and rescue; CT and MRI can show that supraglottic structures such as epiglottis are swollen, the shadow of laryngopharyngeal cavity is narrowed, the boundary is clear, the laryngeal vestibule is funnel-shaped and the epiglottic valley is occluded. CT and MRI are also helpful to identify abscess cavity.

4. After definite diagnosis, bacterial culture and drug sensitivity test should be carried out in the secretion and blood of pharynx and epiglottis, and sensitive antibiotics should be selected.

(3) Judgment of diseases

1. Acute epiglottitis is one of the acute and severe diseases in laryngology, with rapid development and high mortality. Simple acute epiglottitis is more common in adults and can be cured in time.

2. Leak-proof diagnosis In the case of acute laryngitis, swallowing pain and dyspnea, if there is no special lesion in the oropharynx, or there is inflammation in the oropharynx, it is not enough to show that its symptoms are serious. It should be noted that indirect laryngoscopy is necessary for acute epiglottitis.

3. Dyspnea is mainly determined by inspiratory dyspnea, accompanied by high-pitched inspiratory wheezing and expiratory snoring. In children and adults, fulminant patients develop rapidly and can quickly lead to suffocation.

4. Indirect laryngoscope examination for epiglottis abscess shows hyperemia and swelling of epiglottis mucosa; If epiglottic abscess has formed, you will see local uplift with yellow pus spots, pus heads or a small amount of pus leakage. Sudden rupture of abscess can lead to suffocation and life-threatening, so it should be handled correctly in time. Laryngeal x-ray, CT and MRI are helpful to distinguish abscess cavity.

5. Pay attention to the overall situation. Severe patients will have chills, high fever, general malaise, loss of appetite and general pain. Failure will happen quickly to children. Patients may have difficulty swallowing soon, and in severe cases, they will choke and drool. The lighter feels something stuffed in his throat. Occasionally, it's hard to talk. It will cause dehydration and nutritional deficiency, which is not conducive to recovery.

(4) Treatment measures should be based on the principle of keeping respiratory tract unobstructed and resisting infection.

1. Control infection

(1) Application of antibiotics: For those with mild symptoms, penicillin can be used for intravenous drip; If the patient's condition is serious or there is no obvious improvement after the above-mentioned drug treatment, cephalosporin can be injected intravenously.

(2) Application of hormones: hormones can treat and prevent edema such as epiglottis and aryepiglottis, and have nonspecific anti-inflammatory, anti-allergic and anti-shock effects, so the combination of hormones and antibiotics can achieve good therapeutic effects. Generally speaking, the dosage of hydrocortisone for adults is 100~200mg/ time, and dexamethasone is 100 ~ 200mg/ time. Add antibiotics for intravenous drip.

(3) Incision and drainage: If abscess is formed locally, incision and drainage should be performed, which is beneficial to quickly control infection, reduce the dosage of antibiotics, reduce toxemia and shorten the course of disease. If the infection focus is not limited, it should not be cut prematurely to avoid the spread of inflammation. Infants and young children do not need any anesthesia during the operation of incision and pus discharge, and adults use 1% dicaine for surface anesthesia of throat.

2. Keep the respiratory tract unobstructed:

(1) Oxygen inhalation: For sober people with mild dyspnea, it is appropriate to give oxygen at a flow rate of 2 ~ 3L per minute and a concentration of 30%. If the illness is serious, the lack of oxygen is obvious, and there is difficulty in breathing above the second degree, the flow rate and concentration of oxygen per minute should be appropriately increased. At the same time, closely observe the changes of the disease, such as the patient's consciousness, complexion, heart rate, blood pressure and so on. And continue to observe with oxygen; If hypoxia improves, heart rate drops, consciousness deteriorates or respiratory depression occurs, oxygen flow and concentration should be reduced and tracheotomy should be performed as soon as possible.

(2) Tracheotomy: It is an important method to rescue critical cases of this disease. Tracheotomy should be performed as soon as possible under the following circumstances:

(1) The disease develops rapidly and it is difficult to breathe.

② Patients with severe illness, excessive throat secretions and dysphagia.

③ The epiglottis and arytenoid epiglottis were highly congested and swollen, and their condition did not improve after anti-inflammatory treatment.

(4) Infants, the elderly, the infirm and those with poor cough function.

(5) syncope, shock or serious complications.

During tracheotomy, the head should not lean back too much, otherwise it may aggravate breathing difficulties or suffocation. Because epiglottis is highly swollen, it is not easy to seal the trachea first, so it is very dangerous to do this operation, so we must make full preparations to prevent accidents.