Diagnosis of Epiglottitis
The diagnosis of epiglottitis must be handled carefully, as any interference with the throat can cause the airway to close completely. Because epiglottitis is a medical emergency, doctors act quickly to confirm the diagnosis while ensuring the airway remains open. In most cases, a clinical diagnosis is made based on symptoms alone.
Clinical Evaluation
Doctors begin by assessing:
Breathing difficulty
Stridor (noisy breathing)
Drooling
Difficulty speaking or swallowing
General signs of distress or anxiety
In children, the classic “tripod” posture—leaning forward, mouth open, and chin up—is a strong diagnostic clue. The child may also avoid speaking or crying, as both can worsen the airway obstruction.
Visual Inspection
Direct visual examination of the throat is not recommended in a distressed child, as it could trigger full airway blockage. In a controlled hospital setting, trained specialists may gently examine the throat using a flexible laryngoscope to view the epiglottis. In epiglottitis, the epiglottis appears swollen, red, and “cherry-like.”
Imaging
If the airway is stable, doctors may use a neck X-ray to look for the “thumb sign,” which indicates swelling of the epiglottis. However, imaging is not always necessary and should never delay treatment.
Blood and Swab Tests | Diagnosis of Epiglottitis
Once they secure the airway, doctors may take:
Blood cultures, to identify the bacteria causing the infection
Throat swabs, if safe, to test for bacterial or viral infections
Full blood count, to check for raised white blood cells indicating infection
In South Africa, rural hospitals may have limited access to ENT specialists. However, trained emergency staff can often recognise the condition and begin life-saving treatment even without advanced testing.
The diagnosis of epiglottitis relies on recognising the warning signs and acting fast. A delay in diagnosis can lead to complete airway closure and death.
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