ally follows bacterial PHARYNGITISsuch as “strep”
throat.
Symptoms of the infection begin suddenly and
worsen rapidly. Key symptoms include
- sore throat
- high FEVER(above 102°F)
- gasping for breath and stridor (high-pitched
sounds on inhalation) - profuse drooling
- desire to sit upright with the neck extended
and the head tilted forward
Treatment is immediate hospitalization for
administration of intravenous ANTIBIOTIC MEDICA-
TIONSand often insertion of a breathing tube to
maintain breathing until the swelling subsides. This
course of treatment typically brings the infection
under control within 48 to 72 hours, though hospi-
talization may be necessary for a week or longer.
Prompt medical treatment of epiglottitis usually
leads to complete recovery. The routine IMMUNIZA-
TIONof infants and children with the Hib vaccine
has greatly contributed to the steady decrease in
instances of this life-threatening infection.
See also BACTERIA; BREATH SOUNDS; TONSILLITIS.
epistaxis The clinical term for a bloody NOSE. The
inner nasal passages have a rich and plentiful sup-
ply of BLOODvessels, and there are many causes
for epistaxis. During an episode of epistaxis, blood
may come from the nostrils or from the back of
the nose and into the nasopharynx (back of the
THROAT). Most people who have normal clotting do
not lose a significant amount of blood during an
epistaxis episode, even when bleeding appears
profuse. Blood loss often appears greater than it is
because the blood mixes with nasal secretions.
To slow or stop epistaxis:
- Keep the head upright.
- Apply firm pressure to both nostrils using the
thumb and forefinger. - Hold the pressure for at least 10 minutes with-
out release.
The most common causes of epistaxis are
injuries due to local irritation (notably insertion of
fingers, especially in children, and presence of for-
eign objects in the nasal passages), BREATHINGdry
and especially cold air, heavy sneezing, nasal
polyps, and external trauma such as a blow to the
nose or face. Epistaxis may also indicate deviated
septum, which alters the flow of air through the
nostrils and exposes the nasal lining to chronic
irritation.
People who have bleeding disorders, regularly
take NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS) including aspirin, or who have uncon-
trolled HYPERTENSION (high BLOOD PRESSURE) are
more likely to experience heavy epistaxis, though
these circumstances do not usually cause the
bleeding. Epistaxis is usually self-limiting (the
bleeding stops following initial treatment) and
does not require a doctor’s attention.
A doctor should evaluate bleeding that persists
after taking basic measures to stop the nosebleed.
A heavy blood flow may require, with local anes-
thetic, cauterization to seal the bleeding area or
medicated packing (gauze strips, absorbent pled-
gets, or nasal tampons) placed into the area of the
bleeding to hold continuous pressure against the
blood vessels. Doctors typically prescribe a course
of oral ANTIBIOTIC MEDICATIONSwhen it is necessary
to place nasal packing, to safeguard against SINUSI-
TIS (bacterial INFECTION of the SINUSES) or TOXIC
SHOCK SYNDROME(a serious systemic bacterial infec-
tion). The doctor must remove any nasal packing,
typically three days after its placement.
When extended treatment becomes necessary,
the doctor will also request blood tests to assess
blood cell counts and CLOTTING FACTORSand may
choose to admit the person to the hospital for
monitoring of the bleeding as well as the ability to
maintain adequate breathing. Severe bleeding
may require BLOOD TRANSFUSIONor infusions of
clotting factors. Rarely surgery is necessary to
halt the bleeding, usually when the cause is
external trauma or there are underlying health
conditions that prevent the body’s clotting mecha-
nisms from properly functioning. Most often epis-
taxis is a minor problem that quickly resolves,
though a doctor should evaluate recurring nose-
bleeds.
See also BACTERIA; BLEEDING CONTROL; COAGULA-
TION; NASAL POLYP; SEPTAL DEVIATION; THROMBOCY-
TOPENIA.22 The Ear, Nose, Mouth and Throat