ENT - Throat = Epiglottitis, Quinsy

Question 1

Epiglottitis - what is it?

Answer 1

Epiglottitis is inflammation and swelling of the epiglottis caused by infection, typically with haemophilus influenza type B

The epiglottis can swell to the point of completely obscuring the airway within hours of symptoms developing

Epiglottitis is a life threatening emergency

Question 2

Epiglottitis - clinical features?

Answer 2

• Rapid onset
• Patient presenting with a sore throat and stridor
• Drooling
• Tripod position, sat forward with a hand on each knee
• High fever
• Difficulty or painful swallowing
• Muffled voice
• Scared and quiet child
• Septic and unwell appearance

Question 3

Epiglottitis - diagnosis?

Answer 3

Diagnosis is made by direct visualisation

X-rays:

Lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’

Question 4

Epiglottitis - management?

Answer 4

• Protect the airway - immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)
  
  • endotracheal intubation may be necessary to protect airway
• if suspected do NOT examine the throat due to the risk of acute airway obstruction
• oxygen

Once airway is secure:

• IV antibiotics (e.g. ceftriaxone)
• Steroids (i.e. dexamethasone)

Question 5

Epiglottitis - what do you do once airway is secured?

Answer 5

Once airway is secure:

• IV antibiotics (e.g. ceftriaxone)
• Steroids (i.e. dexamethasone)

Question 6

Peritonsillar abscess (quinsy) - what is it?

Answer 6

Peritonsillar abscess is a complication of untreated or partially treated tonsillitis, although it can arise without tonsillitis

Peritonsillar abscess arises when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils

Question 7

Quinsy - clinical features?

Answer 7

severe throat pain, which lateralises to one side

deviation of the uvula to the unaffected side

trismus (difficulty opening the mouth)

Change in voice due to the pharyngeal swelling, described in textbooks as a “hot potato voice”

reduced neck mobility

Painful swallowing

Question 8

Quinsy - what are the key symptoms that indicate a quinsy?

Answer 8

• Change in voice due to the pharyngeal swelling, described in textbooks as a “hot potato voice”
• trismus (difficulty opening the mouth)
• Swelling and erythema in the area beside the tonsils

Question 9

Quinsy - what is the most common causative organism? What are two other organisms that can cause it?

Answer 9

The most common organism is streptococcus pyogenes(group A strep)

Two others: Staphylococcus aureus and haemophilus influenzae