Adhijihwa Throat Disorder (Epiglottitis) Causes, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Adhijihwa is an oral disorder, compared with epiglottitis. It is explained as mukha roga i.e. disease of buccal cavity or mouth explained in the ‘kanta gata roga’ section of ‘diseases of throat’. So, Adhijihva is generally classified under disorders of buccal cavity and specifically categorized under throat disorders. Adhi = extra, Jihwa = tongue.
Read – Diseases Of Lips (Oshtagata Rogas) – Types, Symptoms Treatment

Causes

Causal dosha – kapha predominant
Involved dhatu (tissue) – blood tissue
The vicious combination of vitiated kapha and blood tissue is responsible for the causation of this disorder.

Kapha and rakta (blood) aggravating foods and activities are contributory.
Read – Signs Of Person Having Enriched Blood (Rakta Sara Purusha Lakshanas)

Pathogenesis

• Excessive consumption of etiological factors (foods, activities etc) which cause aggravation of kapha and blood
• Admixture of aggravated kapha and blood forming a vicious combination
• The aggravated kapha-blood combination gets lodged in the throat, mainly at the root of the tongue
• Swelling is of the shape of tongue (tip of the tongue) is formed at / near / over the root of the tongue
• This disease of the throat is called as adijihwaka

Since the swelling is of the shape of a small tongue formed at the root of the tongue, it looks like a small tongue appearing over the tongue. Therefore it is called adhijihva i.e. double tongue or extra tongue or tongue over the tongue.
Read – Uvulitis (Galashundi) – Causes, Symptoms, Treatment

Symptoms

The main symptom of adhijihwa is represented in the name of the disease itself. The swelling of the shape of a tongue occurring at the root of the tongue is the main symptom of the disease.

Prognosis

If suppuration occurs in the swelling of adhijihva it should not be treated. This is because the infection and suppuration could spread out with great speed and intensity. This would make the prognosis difficult and the disease becomes incurable.
Read – Ayurvedic Tongue Examinations Explained In Vaidya Sara Sangraha

Other opinions

According to Master Charaka
The swelling which occurs above the tongue is called as upajihva. The swelling which occurs below the tongue is called as adhijihwa.

According to Master Vagbhata
‘Adijihva is a condition wherein there is an elevation along with swelling beneath the tongue. This swelling appears like the tip of the tongue. It is caused due to vicious combination of kapha, pitta and blood. Symptoms include excessive salivation, stiffness of the tongue, obstruction of voice, pain, itching, inability to speak and inability to swallow food and liquids’.

Here we can see that Master Vagbhata has mentioned pitta apart from kapha and blood in the pathogenesis of the disease against Master Sushruta and Madhavakara who have mentioned only kapha and blood. Master Vagbhata has mentioned wide array of symptoms while Master Sushruta (and Madhavakara) have just mentioned the presence of only swelling at the root of the tongue. These symptoms might be caused following the appearance of or as an effect of the swelling or if the swelling is not treated properly. This shows that Master Sushruta has mentioned the condition only until the appearance of the swelling and Master Vagbhata has gone ahead to mention the other symptoms of the disease and probably its complications like difficulty in swallowing and speaking.
Read – Dry Mouth Causes, Ayurvedic Treatment, Remedies, Tips, Diet

Sanskrit verses

Treatment

The treatment of adhijihwa is done on the similar lines of treating upajihwa disorder.
Master Vagbhata has mentioned a surgical process for treating adhijihwa disorder. Herein the swelling of adhijihva should be opened with the help of instruments and the contents are discharged / drained. Later it should be rubbed with powder of yavakshara – alkali obtained by burning the whole plant of barley.

Modern Correlation

Adhijihwa throat disorder is compared to ‘epiglottitis’ – a condition explained in the modern medicine. This condition is characterized by the swelling / inflammation of epiglottis.
Read – Ranula (Upajihwika) Oral Disorder – Symptoms, Ayurvedic Treatment

Epiglottitis

Epiglottis is a small structure present at the base of the tongue. Most of it is made up of cartilage. The food and liquids that we consume needs to go straight down into the stomach through the food pipe i.e. esophagus. Epiglottis prevents the entry of these things into the windpipe and thus acts like a valve.

Epiglottitis is a condition characterized by swelling / inflammation of the epiglottis. It is considered to be a life threatening illness. In this, the epiglottis tissue might get infected and get swollen. This might block the airway. This is an emergency which needs immediate medical attention. This condition is usually found in children. It is also frequent in adults. Children are more vulnerable to breathing complications and hence a prompt diagnosis and timely treatment is needed. Adults with this condition too need prompt treatment.
Read – Laryngitis (Swelling of voice box) – Causes, Ayurvedic Treatment

Causes of Epiglottitis

Infection – The most common cause is bacterial infection, mainly H. influenza type B (Hib). This can enter your body when you inhale germs spread by an infected person through cough, sneeze or blowing of nose.

Hib infection was considered as the most common cause for swelling and inflammation of epiglottis and the tissues surrounding it in the past. Now days it is less common especially in developed countries. This is mainly due to Hib immunization in children. Hib mainly spreads through infected droplets through cough or sneeze. Hib can stay in the nose and throat without causing any sickness. In this case the person would be able to spread the bacteria to the others.

Other agents – In case of adults the inflammation of epiglottis can also be caused by other bacteria and viruses including

• Streptococcus A, B or C
• Streptococcus pneumonia
• Staphylococcus aureus
• Shingles virus
• Chickenpox virus
• Viruses that cause respiratory infections
• Fungi (those which causes diaper rash)
• Yeast infections

Streptococcus A can cause strep throat. S. pneumonia is a common cause of bacterial pneumonia.

Other causes

• Chemical inhalation
• Chemical burns
• Burns from hot liquids / burns caused due to drinking very hot or caustic liquids
• Smoking crack cocaine
• Throat burn (from steam or other sources of heat)
• Swallowing a foreign object
• Swallowing chemicals that might burn the throat
• Throat injury – trauma (stab, gunshot wound etc) i.e. direct injury / blow to the throat
  Read – Tonsillitis Ayurvedic Treatment, Herbs, Home Remedies

Symptoms

Immaterial of the cause, the symptoms of epiglottitis are the same. The symptoms may differ between adults and children. This condition may develop within few hours in children while it develops slowly in adults.

Symptoms common in children

• High fever
• Sore throat / hoarse voice
• Stridor (abnormal sound while breathing which is high pitched)
• Difficulty in swallowing food and water
• Pain while swallowing
• Breathing through mouth
• Drooling
• Restlessness and anxious behavior
• Lessened symptoms (feels better) while sitting upright or leaning forward
  Read – Symptoms That Hint Towards Different Diseases In Babies

Symptoms common in adults

In adults the signs and symptoms may develop slowly in comparison to the children. They may develop over number of days rather than in few hours as happens in children. The symptoms include –

• Fever
• Difficulty in breathing
• Difficulty in swallowing
• Noisy / harsh breathing
• Severe sore throat
• Muffled voice / raspy / hoarse voice
• Inability to catch their breath
• Drooling
• Stridor

Epiglottitis would block your airways completely if it is not promptly treated. There will be lack of oxygen which would present as bluish discoloration of the skin. This is a grave emergency and needs immediate medical attention.

Risk factors

Anyone, children or adults, as already said can develop epiglottitis. On the other hand, there are many factors which can increase the risk of developing this condition. They include –

• Children younger than 12 months of age (these children have not yet completed the Hib vaccine series)
• Children in the age group of 2-6 years
• Adults older than 85 years of age
• Children living in the countries wherein the vaccines are not offered
• Parents choosing not to vaccinate their children for various reasons
• Inadequate vaccination – a child may be vulnerable to Hib and thus increase the risk of epiglottitis if the immunizations are skipped or delayed
• Males are more prone in comparison to the females
• Living or working amidst larger groups of people
• Heavily populated environments (schools, child care centers)
• Weak immune system (makes one susceptible for infections that might land up causing epiglottitis)
• Diabetes (adults)
  Read – Swarna Bindu Prashana: Ayurvedic Immunization Method

Complications

Respiratory failure – Due to swelling of epiglottis the airways become narrow and may get completely blocked. This can lead to respiratory failure. It is a life threatening condition. Herein the blood oxygen levels drop to dangerously low levels or the carbon dioxide levels become excessively high.
Spreading infection – The same bacteria that causes epiglottitis might cause infection in other places of the body also leading to many conditions like pneumonia, meningitis or bloodstream infection.

Diagnosis

Medical history and physical observations help in clinching the diagnosis of epiglottitis.
On priority basis one should ensure that the child’s airway should be kept open and enough oxygen is getting through. Breathing and blood oxygen levels shall be recorded regularly. After the breathing has been stabilized the below mentioned tests may be conducted / advised so as to support the diagnosis –

• X-rays of throat and chest
• Throat and blood cultures
• Throat examination with fiber optic tune

What to consult doctor?

If there is severe difficulty in swallowing or breathing one should call or report to the doctor or nearest emergency department as soon as possible since epiglottitis is a medical emergency. The person should be kept upright and quiet. This position would ease the breathing process.
Read – Dyspnoea – Difficulty in breathing: Causes, Pathophysiology, Diagnosis

Prevention

• Regular Hib vaccine doses – The most effective way to prevent epiglottitis caused by Hib is immunization with Hib vaccine. Two to three doses of Hib vaccine shall be provided to children. Children usually receive this vaccination (in US) in 3 or 4 doses. The dose shall be started at 2 months of age. The next two doses are usually given at 4^th and 6^th months. Booster dose shall be given between 12 and 15 months of age.
• Children older than 5 years of age or adults are less likely to develop Hib infection. Therefore the vaccine is generally not given in these cases. If the immune system has been weakened by sickle cell disease, HIV (AIDS), removal of spleen, chemotherapy or medications to prevent organ rejection or bone marrow transplants the Hib vaccine shall be administered to even older children and adults.
• Hib vaccine may cause allergic reactions or possible mild side effects. If this happens, it needs to be immediately brought to the notice of the doctor.
• Frequent hand wash – One should wash hands frequently. He or she may use sanitizer to prevent the germs from spreading.
• Avoid – One should avoid sharing the same cup for drinking water or tea or any liquid. Foods and utensils too shall not be shared.
• Healthy foods – One should be choosy about foods and eat healthy foods.
• Avoid smoking – One should avoid smoking or take help to discontinue the same.
• Rest – One should get adequate rest.
• Proper treatment – One should take timely treatment and properly manage all chronic medical conditions he or she is suffering.
  Read – Bronchitis Causes, Symptoms, Types, Treatment, Ayurveda Concept

Precautions

One should follow precautions in spite of having taken Hib vaccine since the vaccine doesn’t assure the non occurance of the disease. Epiglottitis is found to happen even in children who have been vaccinated. And other germs too can cause epiglottitis. Precautions include –

• not sharing personal items with others
• washing hands frequently
• using hand sanitizer (alcohol based) if water and soap are not available

Treatment

As a priority, the breathing is restored. Following this, any identified infection shall be treated.
Protection of airways – will be the first approach towards treating epiglottitis. While doing this, the physician would also keep an eye and constantly monitor the blood oxygen levels. Oxygen may be provided if blood oxygen levels are too low.

Help to breathe
It is important to see that the patient is receiving enough air. This includes –

• Wearing mask
• Intubation (breathing tube placed into the windpipe through nose or mouth)
• Cricothyroidotomy (inserting needle into the trachea)

Other measures – Along with this, the below mentioned also may be included as and when required –

• IV fluids to supplement nutrition and hydration
• Antibiotics if there is bacterial infection or is suspected
• Anti-inflammatory medications to reduce swelling

Treating the infection
Intravenous antibiotics will be given if epiglottitis is caused due to infection.
Broad spectrum antibiotics – The infections need to be quickly handled and treated. For this the doctor would prescribe broad-spectrum drugs (antibiotics) immediately, without even waiting for the results of blood and tissue cultures.
Tracheostomy or Cricothyroidotomy – procedures may be needed in severe cases of epiglottitis.
Full recovery can be expected in most cases of epiglottitis if immediate medical attention is sought for.
Read – Atelectasis Causes, Symptoms, Treatment, Ayurveda Concept

Overview
Epiglottitis can occur at any age. This condition has now become rare since Hib vaccination are given promptly. But the condition is still a point of concern. Emergency help needs to be sought out if there is a suspicion of someone suffering from epiglottitis. Life threatening complications of epiglottitis can be prevented if this condition is treated promptly.

Click to Consult Dr Raghuram Y.S. MD (Ayu) – Skype