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Sore throat - acute - Making a diagnosis
Epiglottitis

  • Until recently, the typical presentation has been a 2–4 year old child with a short history of fever, irritability, dyspnoea, dysphonia and dysphagia, pooling of oral secretions, and drooling of saliva. However as the use of Haemophilus influenzae type b conjugated vaccine increases, the typical person presenting with epiglottitis is an adult rather than a child. Sore throat is the most prominent symptom in older children and adults [Moxon, 2003; Burns and Hendley, 2005].
  • There is a rapidly progressive cellulitis of the epiglottis and adjacent structures that has the potential to cause abrupt and complete airway obstruction. People with suspected epiglottitis should not have their throat examined unless there are facilities for immediate intubation/tracheotomy because of the possibility of precipitating complete airway obstruction or cardiopulmonary arrest [Moxon, 2003; Burns and Hendley, 2005]:
  • In children:
    • A child with epiglottitis prefers to sit leaning forward. Breathing tends to be tentative and careful, without marked increase in respiration rate. Inspiratory stridor and hoarseness may occur [Bisno, 2005].
    • Tachycardia may be out of proportion to the fever if hypoxia is present [Bisno, 2005].
    • The voice and cry are muffled and the child may be reluctant to talk [Moxon, 2003].
    • Inspiratory stridor and hoarseness may occur but the barking cough and aphonia that occur with croup are rare [Tice, 2005].
  • In adults:
    • There is severe sore throat with painful swallowing [Bisno, 2005].
    • Predictors of airway compromise include sitting erect, stridor, and dyspnoea [Bisno, 2005].
  • A study of 35 people (34 adults and 1 infant) presenting with epiglottitis in Denmark found that 94% had painful swallowing, 60% had drooling, 57% had a history of fever, and 29% had a muffled voice. Only 4% had stridor [Guldfred et al, 2007].

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