Epiglottitis is the term used to describe inflammation and swelling of the epiglottis which lies just behind the root of your tongue. It is usually caused by infection with a germ (bacterium). The usual symptoms are a severe sore throat, pain or difficulty swallowing and a high temperature (fever). Breathing difficulties can occur. Prompt treatment is needed to ensure that enough oxygen can reach the lungs, and includes antibiotics. If epiglottitis is treated quickly, the outlook is generally very good. Untreated, it can be life-threatening. Since immunisation against Hib was introduced, the number of children who develop epiglottitis in the UK has reduced dramatically.
What is epiglottitis and what causes it?
Epiglottitis is inflammation of the epiglottis. It is almost always caused by infection with a germ (bacterium). The common bacteria that cause epiglottitis are Streptococcus pneumoniae and Haemophilus influenzae type b (Hib).
Infection leads to inflammation and swelling of the epiglottis. If the epiglottis swells, because of its position in your throat, it can affect your breathing by blocking (obstructing) the passage of air through your voice box (larynx) to your windpipe (trachea) and your lungs.
Epiglottitis can be confused with croup which is a common childhood viral infection affecting the voice box and windpipe. Croup is far less dangerous than epiglottitis and improves on its own. See the separate leaflet called Croup for more details.
Who gets epiglottitis and how common is it?
Epiglottitis can occur at any age. In children it most commonly affects those between the ages of 2 and 5 years. However, since the Hib vaccine was introduced in the UK and other countries in the 1990s, the number of children who develop epiglottitis has reduced dramatically. It is now extremely rare. See the separate leaflet called 6-in-1 Vaccine (Including DTaP, Polio, Hib and Hep B Immunisations for more details.
As the use of the Hib vaccine increases, this has meant that the typical person who develops epiglottitis is an adult rather than a child. However, it is still rare for adults to get epiglottitis. You are more at risk if your immune system does not work properly - for example, if you have had chemotherapy or if you have HIV.
What are the symptoms of epiglottitis?
High temperature (fever) is usually the first symptom. Someone with epiglottitis will also complain of a very sore throat. They may have a hoarse voice and pain on swallowing. Because of the pain on swallowing, they may drool saliva. Coughing is not a common symptom.
Noisy breathing and breathing difficulty then follow and need to be treated quickly. Someone with epiglottitis usually prefers to sit upright and lean slightly forwards, often with their tongue sticking out (protruding). This position helps to open up their airway to let more oxygen through to the lungs. Someone with epiglottitis can be quite scared and panicked. You may hear a grunting noise as they try to breathe. As less oxygen gets through to the lungs, their skin colour can change and can become grey or blue.
If treatment is not started quickly, the swelling of the epiglottis can totally block (obstruct) the airway. This means that air is not able to reach the lungs and this can cause collapse and death.
In general, adults with epiglottitis tend to have less severe symptoms than children and the symptoms tend to develop more slowly.
How do I check my child for epiglottitis?
Your child may have epiglottitis if they:
- Have a very sore throat.
- Have difficulty breathing.
- Make a high-pitched wheezing sound when they breathe.
- Have a muffled or hoarse voice.
- Start drooling.
How is epiglottitis diagnosed?
If someone has suspected epiglottitis, they should be admitted to hospital immediately. It should be treated as an emergency by calling 999/112/911 for an ambulance. Do not lay the person down or try to look in their throat, as this can cause the throat to close off completely and may cause breathing to stop altogether.
Epiglottitis is usually diagnosed by the typical symptoms. A procedure called a nasopharyngoscopy or laryngoscopy may be used, once you are in hospital, to help confirm epiglottitis. A thin flexible tube is run down your nose into your throat. The doctor is able to see through the tube and look for swelling or redness of the epiglottis.
Sometimes an X-ray of your neck is taken and this can show a swollen epiglottitis. A swab is also usually taken from your throat and sent to the laboratory to look for infection. A blood sample may also be taken, again to look for signs of infection. A computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may also be needed.
What is the treatment for epiglottitis?
If someone has epiglottitis, the most important treatment is to ensure that they are getting enough oxygen into their lungs. For example, oxygen can be given using a mask over their mouth and nose. Sometimes someone may need help with their breathing, using a ventilator. A ventilator is a machine that is mechanically operated to maintain the flow of oxygen and air into and out of the lungs.
In severe cases, if the epiglottis is swollen and blocking the airway, even if oxygen is given, it would not be able to reach the lungs. So, a procedure called a tracheostomy is done. This is where a small cut is made in the windpipe (trachea). This allows a tube to pass below the swollen epiglottis so that oxygen can be delivered to the lungs. Someone with a tracheostomy may also need help with their breathing using a ventilator.
Antibiotics are another important part of the treatment. They help to fight the infection. An antibiotic which is capable of dealing with a wide range of germs (a broad-spectrum antibiotic) is usually used - eg, ceftriaxone. It is usually given directly into a vein (intravenously) from a drip. A steroid medicine may also be given to help reduce the inflammation around the epiglottis.
If someone with epiglottitis is having trouble with their breathing and they need to be ventilated or need a tracheostomy, they will usually be transferred to an intensive care unit. They will be kept on the ventilator until the antibiotics have started to work and the inflammation of the epiglottis has had time to improve.
Epiglottitis is a medical emergency that needs to be treated in hospital. This is because the person's breathing needs to be monitored and medicines need to be given intravenously. Also, if there is difficulty swallowing, a drip may be needed to provide nourishment and fluid directly into a vein.
With prompt treatment, most people recover in a few days and are able to leave hospital in about a week.
Are there any complications of epiglottitis?
If epiglottitis is not treated quickly, the airway can become totally blocked. This means that air is not able to get into the lungs and the person can die. However, if epiglottitis is treated quickly, the outlook is generally very good. Recovery usually takes about seven days in children and may be a little longer in adults.
Occasionally, a collection of pus can collect in the area of the epiglottis (an epiglottic abscess). This is mainly seen in adults. It sometimes requires surgical drainage.
Rarely, infection can spread from the epiglottis to other parts of the body, including the ear, the brain, the heart and the lungs.
Can epiglottitis be prevented?
The Hib vaccine is advised for all babies at age 2, 3, 4 and 12 months. This has led to a dramatic reduction in cases of epiglottitis in children. However, as with all vaccines, it is not always 100% effective. Epiglottitis may also be caused by other germs (bacteria).
Close contacts of someone who has been diagnosed with epiglottitis (for example, people who live in the same household) may also be given antibiotics to help reduce the chance of them developing the infection.
What is the epiglottis?
The epiglottis is a leaf-shaped flap of cartilage tissue that lies just behind the back of your tongue.
When you swallow, your epiglottis covers your voice box (larynx) stopping food from entering your windpipe (trachea). Your voice box is in the front of your neck above your windpipe. It contains your vocal cords and also allows air to pass from your mouth into your windpipe, and from there to your lungs.
Further reading and references
Glynn F, Fenton JE; Diagnosis and management of supraglottitis (epiglottitis). Curr Infect Dis Rep. 2008 May10(3):200-4.
Bizaki AJ, Numminen J, Vasama JP, et al; Acute supraglottitis in adults in Finland: review and analysis of 308 cases. Laryngoscope. 2011 Oct121(10):2107-13. doi: 10.1002/lary.22147. Epub 2011 Sep 6.
Chen C, Natarajan M, Bianchi D, et al; Acute Epiglottitis in the Immunocompromised Host: Case Report and Review of the Literature. Open Forum Infect Dis. 2018 Feb 175(3):ofy038. doi: 10.1093/ofid/ofy038. eCollection 2018 Mar.
O'Bryant SC, Lewis JD, Cruz AT, et al; Influenza A-Associated Epiglottitis and Compensatory Pursed Lip Breathing in an Infant. Pediatr Emerg Care. 2018 Sep 21. doi: 10.1097/PEC.0000000000001589.
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