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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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The doctor may order X-rays or simply look at the epiglottis and the windpipe by laryngoscopy-a procedure performed in an operating room.

• The doctor may find that the pharynx is inflamed with a beefy cherry red, stiff, and swollen epiglottis.
• There should be no attempt at home to inspect the throat of a person suspected of having epiglottitis.
• Because manipulation of the epiglottis may result in sudden fatal airway obstruction and because irregular slow heart rates have occurred with attempts at intubation (putting a tube down the throat and placing the person on a machine that helps with breathing), the doctor will use the controlled environment of an operating room to see the throat structures.

Other laboratory tests that doctors use to evaluate patients may include the following:

• Blood tests to look for infection or inflammation
• Arterial blood gas, which measures oxygenation of the blood and the severity of obstruction
• Blood cultures, which may grow bacteria and indicate the cause of the epiglottitis
• Other immunologic tests looking for antibodies to specific bacteria or viruses

These laboratory tests may not be useful in diagnosing epiglottitis until the person is stable. Also, the anxiety from having blood drawn or cultures taken from the throat may cause the unstable epiglottis to close off, completely obstructing the airway and creating an emergency with only a few minutes to correct.

Even with modern technology, epiglottitis is not easy to diagnose. Early in the disease, epiglottitis is commonly misdiagnosed as strep throat.

• Other possible diagnoses include infectious causes such as croup, diphtheria, peritonsillar abscess, and infectious mononucleosis.
• Noninfectious causes have been mistaken as angioneurotic edema (swelling of the tissues in the airway), laryngeal inflammation or spasm, laryngeal trauma, cancerous growths, allergic reactions, thyroid gland infection, epiglottic hematoma, hemangioma, or inhalational injury.
• It is often easy to mistake epiglottitis for croup. Epiglottitis differs clinically from croup by its progressive worsening, lack of a barking cough, and a cherry red swollen epiglottis versus a red nonswollen epiglottis in croup. One way doctors can tell epiglottitis from croup is with X-rays of the neck.

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