Epiglottic inversion is a medical condition where the epiglottis, a crucial flap of cartilage in the throat, folds backward. This abnormal movement impedes its protective role during swallowing. When this occurs, the airway may become compromised, affecting a person’s ability to breathe properly. Understanding this complex issue is important for recognizing its potential impact on respiratory health.
The Epiglottis and Its Normal Function
The epiglottis is a small, leaf-shaped piece of elastic cartilage at the top of the larynx, or voice box, and behind the tongue. It remains upright during normal breathing, ensuring an unobstructed path for air to enter the lungs.
During swallowing, muscle movements cause the epiglottis to fold backward. This action covers the entrance to the larynx and trachea, preventing food, liquids, or saliva from entering the respiratory system. The swallowed material is directed into the esophagus, which leads to the stomach. After swallowing, the epiglottis returns to its upright position, reopening the airway for respiration. This mechanism is crucial for preventing choking and aspiration, where foreign material enters the lungs, potentially leading to serious infections like pneumonia.
Causes and Manifestations of Epiglottic Inversion
Epiglottic inversion typically results from inflammation and swelling of the epiglottis, most frequently a bacterial infection known as epiglottitis. While Haemophilus influenzae type b (Hib) was historically a primary culprit, the Hib vaccine has significantly reduced its incidence. Other bacteria, such as Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus, are now common causes.
Beyond bacterial infections, epiglottic inflammation and inversion can stem from non-infectious factors. These include direct trauma to the throat, like physical injury or prolonged breathing tube presence. Thermal injuries from ingesting hot liquids or chemical burns can also lead to swelling and impaired epiglottic movement. Structural abnormalities or neurological conditions affecting swallowing may also contribute.
Symptoms, particularly when caused by acute epiglottitis, often develop rapidly and can be severe. Initial symptoms include a sudden, intense sore throat and difficulty swallowing. As the epiglottis swells and obstructs the airway, individuals may experience difficulty breathing, a high-pitched whistling sound (stridor), and drooling.
Other signs include a muffled voice, fever, and general distress. Young children might lean forward with their mouth open and neck extended in a “tripod position” to maximize airflow. Epiglottic inversion is a medical emergency that requires immediate attention to prevent complete airway obstruction.
Diagnosis and Management of Epiglottic Inversion
Diagnosing epiglottic inversion requires prompt medical evaluation due to the potential for rapid airway compromise. Clinical suspicion often arises from the characteristic symptoms, such as severe sore throat, drooling, difficulty swallowing, and stridor. Healthcare providers typically avoid agitating the patient, especially children, as this can worsen airway obstruction.
Direct visualization of the epiglottis is the most accurate diagnostic method, commonly performed using a flexible fiberoptic laryngoscope in a controlled environment where airway management equipment is readily available. A lateral neck X-ray may sometimes show a characteristic “thumb sign” indicating an enlarged epiglottis. This imaging is typically pursued only if the patient is stable and the diagnosis remains unclear.
Immediate management focuses on securing the patient’s airway. For individuals experiencing significant breathing difficulties, intubation (inserting a tube into the trachea) is a primary intervention to ensure adequate oxygen supply. If intubation is not feasible or effective, a tracheostomy (surgical opening in the neck to access the trachea) may be necessary.
Once the airway is stabilized, medical treatment addresses the underlying cause, usually a bacterial infection. Intravenous antibiotics, such as third-generation cephalosporins like ceftriaxone, are administered to combat the infection. Corticosteroids, like dexamethasone, may also be given to help reduce inflammation and swelling. Patients receive supportive care, including humidified oxygen and close monitoring in an intensive care setting, to assess their response to treatment and prevent further complications. With timely and appropriate intervention, the prognosis is generally favorable, although untreated cases can be fatal due to complete airway obstruction.