Epiglottitis Diagnosis

• Evaluate for presence & severity of airway obstruction based on history & physical examination
  • Patients on “tripod” position are most likely suffering from severe epiglottitis & needs immediate treatment
• Direct examination of the pharynx in patients whose signs & symptoms are highly suggestive of epiglottitis should be deferred
• Stabilize airway prior to performing diagnostics

Culture

• Culture should be performed by obtaining a swab of the epiglottis during the airway stabilization
  • 60-98% reveals H influenzae type b infection
• Blood cultures should also be obtained once airway has been established

Other Tests

• Complete blood count may reveal leukocytosis

Laryngoscopy

• Visualization of the posterior pharynx is the best way to confirm the diagnosis
• The procedure should be performed speedily in a controlled environment [eg an operating room or an intensive care unit (ICU) where intubation may be promptly performed in the event of airway obstruction]
• Administration of an inhaled anesthetic may allow an expeditious exam of the airway but an expert in intubation should be on stand by
• A large, cherry-red epiglottis is usually seen
  • Aryepiglottic folds & base of the tongue may also be inflamed
• An older cooperative child may voluntarily open the mouth wide enough to permit the direct view of the inflamed epiglottis

Radiography

• If epiglottitis is considered possible, but not probable, the patient may first undergo x-rays of the upper airway
• The “thumb sign” which results from edema & enlargement of the epiglottis may be seen
  • Absence of the “thumb sign” does not rule out epiglottitis, but it tells the clinician that examination of the pharynx may be done w/o great danger of airway obstruction
• Other findings indicative of epiglottitis include absence of vallecular air space, thickened aryepiglottic folds, distended hypopharynx & straightening of cervical lordosis

Ultrasonography

• Ultrasound evaluation in older patients usually shows an “alphabet P sign” due to severely inflamed epiglottis & the hyoid bone