A sore throat may be caused by acute epiglottitis, and an instant "throat blockage" is not an exaggeration!

The weather has been dry recently, and many people have sought medical attention due to symptoms such as dry, itchy, sore throats, and a foreign body sensation. Many patients regard these symptoms as "minor problems" and subconsciously believe that they are inflamed or have a sore throat. However, there is a type of sore throat that often disguises itself as pharyngitis or tonsillitis, which can instantly "block the throat" and cause suffocation. It is acute epiglottitis .

On February 21, the topic "Sore throat may be a dangerous emergency" became a hot search on Weibo, attracting the attention of many netizens to the disease of acute epiglottitis. Patients and clinicians must pay enough attention to it, make an accurate diagnosis and provide timely treatment.

Instant "throat blocking" is not an exaggeration

Recently, Mr. Zhang from Ningbo, 56, was hospitalized due to acute epiglottitis. At first, he only had a sore throat. After arriving at the local hospital, the doctor prescribed him oral anti-inflammatory medication and asked him to go home for further observation. Unexpectedly, the symptoms not only did not ease, but became more and more severe. When lying down to sleep at night, Mr. Zhang felt more and more uncomfortable, "It seems like someone is pinching my neck, I'm suffocating! Take me to the hospital..." At 3 a.m., Mr. Zhang covered his chest with both hands and struggled to talk to his family. After that, his family sent him to the hospital. After a dynamic laryngoscopy, the doctor found that Mr. Zhang's epiglottis was severely congested and highly edematous and spherical, which are typical symptoms of acute epiglottitis. He was immediately admitted to the hospital.

Acute epiglottitis is one of the acute and severe diseases in the Department of Otolaryngology . The disease has a sudden onset and rapid onset, which can quickly lead to acute suffocation. It has a very high mortality rate and can occur in both children and adults. Cao Feng, chief physician of the Department of Otolaryngology at the Second People's Hospital of Hefei, said: "The epiglottis is a structure of the human body that acts like a 'lid' to guide food and liquids away from the trachea." Cao Feng said that the online talk of "closing the throat instantly" is not alarmist. "The epiglottis is normally 1 to 2 mm thick, but if it swells due to inflammation, it may swell into a ball, blocking the entrance to the throat and causing suffocation."

Three pathological types of acute epiglottitis

Acute epiglottitis often features hyperemia and edema of the lingual surface of the epiglottis as the main pathological change, which can spread to the aryepiglottic folds, arytenoid cartilages or valleculae, but rarely invades the vocal cords and subglottic area. The epiglottal mucosa is highly hyperemic and swollen, and the edematous epiglottis is often 6 to 7 times thicker than normal. In patients with severe inflammation, local abscesses may form in the later stages of the disease, which can be divided into three types.

1. Acute catarrhal type

Acute catarrhal inflammation of the epiglottic mucosa is manifested by diffuse congestion and edema of the epiglottic mucosa, with infiltration of mononuclear and polymorphonuclear cells. Since the submucosal tissue of the lingual epiglottis is relatively loose, the lingual epiglottis swells significantly.

2. Acute edema

If allergic inflammation occurs in the epiglottis, the mucosal lesions are mainly interstitial tissue edema, inflammatory cell infiltration increases, and the epiglottis swells to a spherical shape, which can easily cause laryngeal obstruction.

3. Acute ulcerative type

It is rare, but the disease progresses rapidly and seriously. The lesions often invade the submucosal layer and glandular tissue, and suppuration and ulceration may occur locally. When the lesions invade the blood vessel wall, it may cause erosion and bleeding of the blood vessel wall.

Master the key points of diagnosis and treatment, and make timely and correct diagnosis!

1. Clinical manifestations

Acute epiglottitis is mainly manifested by severe pharyngeal pain, dysphagia and throat obstruction, as well as reflex ear pain, chest tightness, slurred or muffled pronunciation, and in severe cases, dyspnea, wheezing, hoarseness and drooling. The onset is acute, often occurring suddenly at night, and the history of the disease rarely exceeds 6 to 12 hours.

(1) Chills and fever

In mild cases, the symptoms are not obvious, while in severe cases, there may be varying degrees of fever (37.5-40.0 ℃) and chills.

(2) Throat pain and swallowing dysfunction

Swallowing or food can directly irritate the epiglottis, causing sore throat, salivation, and refusal to eat. The pain can radiate to the mandible, neck, ear, or back. If the epiglottis and the truncal cartilage mucosa are extremely swollen, it can cause dysphagia.

(3) Dyspnea

In severe cases, dyspnea occurs early and progresses rapidly, and can cause suffocation within a few hours. At this time, the patient is more agitated and cannot calm down, and the breathing rhythm becomes shallower and faster, and the "three-depression sign" may appear, that is, the suprasternal fossa, supraclavicular fossa, and intercostal space are obviously sunken when breathing.

2. Clinical examination

(1) Physical examination

Observe the appearance of the neck first, then palpate. In severe cases of acute epiglottitis, the inflammation may spread to adjacent tissues, causing subcutaneous redness and swelling in the anterior neck, tenderness over the thyrohyoid membrane, enlargement and tenderness of the deep upper cervical lymph nodes on one or both sides, and obvious tenderness when the fingers touch the hyoid bone and the upper part of the thyroid cartilage in the neck.

When checking the epiglottis and tongue base, it is advisable to be gentle and try to avoid causing nausea, so as not to aggravate dyspnea and cause suffocation. Do not use too much force, so as not to cause vagal nerve reflex and cardiac arrest. Examination in the supine position may occasionally cause temporary suffocation.

(2) Indirect laryngoscopy

In the early stage of the disease, the epiglottis swells and thickens, and is pale or cherry red, especially on the lingual surface. In severe cases, the epiglottis may swell and become spherical. In the later stage, localized abscesses may form on the lingual surface of the epiglottis, and local bulges may be seen with yellow pus spots, pus heads, or small fistulas with pus discharge, and occasionally with ulcers. When the inflammation involves the aryepiglottic folds and arytenoid mucosa, the mucosa there may be swollen and congested. Because the epiglottis cannot be lifted, the glottis and subglottic area are difficult to see. It is extremely rare for inflammation to involve the laryngeal surface of the epiglottis, but once it is involved, the breathing difficulties will be more severe.

If indirect laryngoscopy is unsatisfactory in observing the epiglottis, direct laryngoscopy or fiberoptic laryngoscopy can be performed.

(3) Imaging examination

X-rays show swelling of the epiglottis, disappearance of the vallecula, narrowing of the pharyngeal cavity, and a "thumb sign" of the epiglottis. Neck CT scans show thickening of the epiglottis and surrounding tissues, disappearance of the pre-epiglottic space, etc. Imaging examinations and related laboratory tests (routine blood tests, arterial blood gas analysis, blood culture, and immunological tests) are not necessary for diagnosis. If the patient has been diagnosed, they can be omitted to avoid delaying treatment and rescue.

How to distinguish acute epiglottitis from sore throat caused by a cold?

Acute epiglottitis has a sudden onset and develops rapidly, which can easily cause upper respiratory tract obstruction. However, the pain in the early stage of the disease is not much different from that of tonsillitis and pharyngitis, and the physiological position of the epiglottis is lower than that of the tonsils, so it is often ignored. A comparison of the two is shown in Table 1.

Table 1 How to distinguish sore throat caused by acute epiglottitis from that caused by a cold

Infection is a common cause of acute epiglottitis and can be prevented by vaccination

Infection is a common cause of acute epiglottitis, which is often caused by bacterial infections such as Haemophilus influenzae type B (i.e. influenza B), hemolytic streptococci, staphylococci and pneumococci, or combined with viral infections, mostly through the respiratory tract. In addition, allergic reactions, laryngeal trauma, and infections of adjacent organs (such as acute tonsillitis, floor of stomatitis, acute rhinitis, etc.) can also induce acute epiglottitis.

Preventing pathogen infection is the key measure to prevent acute epiglottitis. Children can be vaccinated with Haemophilus influenzae type B vaccine to prevent infection with this pathogen. Vaccination is not recommended for adults, except for special groups with low immunity, such as sickle cell anemia, post-splenectomy, tumors, etc., which affect immune function.

References

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[2] Gu Xiaoxia, Gao Feng, Wang Xu. Clinical characteristics and risk factors of recurrent acute infectious epiglottitis in adults[J]. Journal of Clinical Otolaryngology Head and Neck Surgery, 2023(1): 47-51.

[3]Xu Xiujuan, Ma Huaan. Acute epiglottitis, a minor sore throat can be fatal[J]. Jiangsu Health Care, 2022(10): 6-7.

[4] Zhang Huirong, Guan Xiaoli, Chen Li, et al. Early warning assessment and management of suffocation in patients with throat diseases [J]. Journal of Nursing, 2022, 37(21):