Epiglottitis

Date Updated: 10/13/2020

Overview

Epiglottitis is a potentially life-threatening condition that occurs when the epiglottis — a small cartilage "lid" that covers your windpipe — swells, blocking the flow of air into your lungs.

A number of factors can cause the epiglottis to swell — burns from hot liquids, direct injury to your throat and various infections. The most common cause of epiglottitis in children in the past was infection with Haemophilus influenzae type b (Hib), the same bacterium that causes pneumonia, meningitis and infections in the bloodstream. Epiglottitis can occur at any age.

Routine Hib vaccination for infants has made epiglottitis rare, but the condition remains a concern. If you suspect that you or someone in your family has epiglottitis, seek emergency help immediately. Prompt treatment can prevent life-threatening complications.

Symptoms

Symptoms in children

In children, signs and symptoms of epiglottitis may develop within a matter of hours, including:

Fever
Severe sore throat
Abnormal, high-pitched sound when breathing in (stridor)
Difficult and painful swallowing
Drooling
Anxious, restless behavior
Feeling better when sitting up or leaning forward

Symptoms in adults

For adults, signs and symptoms may develop more slowly, over days rather than hours. Signs and symptoms may include:

Severe sore throat
Fever
A muffled or hoarse voice
Abnormal, high-pitched sound when breathing in (stridor)
Difficulty breathing
Difficulty swallowing
Drooling

When to see a doctor

Epiglottitis is a medical emergency. If you or someone you know suddenly has trouble breathing and swallowing, call your local emergency number or go to the nearest hospital emergency department. Try to keep the person quiet and upright, because this position may make it easier to breathe. Don't try to examine the person's throat yourself. This can make matters worse.

Causes

Epiglottitis is caused by an infection or an injury.

Infection

In the past, a common cause of swelling and inflammation of the epiglottis and surrounding tissues was infection with Haemophilus influenzae type b (Hib) bacteria. Hib is responsible for a number of serious conditions, the most common of which is meningitis. Hib is now much less common in developed countries due to Hib immunization in children.

Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib in your nose and throat without becoming sick — though you still can spread the bacteria to others.

In adults, other bacteria and viruses also can cause inflammation of the epiglottis, including:

Streptococcus pneumoniae (pneumococcus), another bacterium that can cause meningitis, pneumonia, ear infection and blood infection (septicemia)
Streptococcus A, B and C, a group of bacteria that can cause diseases ranging from strep throat to blood infection
Staphylococcus aureus, a bacterium that causes skin infections and other diseases including pneumonia and toxic shock syndrome

Injury

Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can burns from drinking very hot or caustic liquids.

You also may develop signs and symptoms similar to those of epiglottitis if you:

Swallow a chemical that burns your throat
Swallow a foreign object
Smoke drugs, such as crack cocaine

Risk factors

Certain factors increase the risk of developing epiglottitis, including:

Being male. Epiglottitis affects more males than females.
Having a weakened immune system. If your immune system has been weakened by illness or medication, you're more susceptible to the bacterial infections that may cause epiglottitis.
Lacking adequate vaccination. Delayed or skipped immunizations can leave a child vulnerable to Hib and increases the risk of epiglottitis.

Complications

Epiglottitis can cause a number of complications, including:

Respiratory failure. The epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering your windpipe. But if the epiglottis becomes swollen — either from infection or from injury — the airway narrows and may become completely blocked. This can lead to respiratory failure — a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high.
Spreading infection. Sometimes the bacteria that cause epiglottitis cause infections elsewhere in the body, such as pneumonia, meningitis or a bloodstream infection.

Prevention

Hib vaccine

Immunization with the Hib vaccine is an effective way to prevent epiglottitis caused by Hib. In the United States, children usually receive the vaccine in three or four doses:

At 2 months
At 4 months
At 6 months if your child is being given the four-dose vaccine
At 12 to 15 months

The Hib vaccine is generally not given to children older than age 5 or to adults because they're less likely to develop Hib infection. But the Centers for Disease Control and Prevention recommends the vaccine for older children and adults whose immune systems have been weakened by:

Sickle cell disease
HIV/AIDS
Spleen removal
Chemotherapy
Medications to prevent rejection of organ or bone marrow transplants

Vaccine side effects

Allergic reaction. Seek immediate medical help if you have an allergic reaction. Though rare, an allergic reaction may cause difficulty breathing, wheezing, hives, weakness, a rapid heartbeat or dizziness within minutes or a few hours after the shot.
Possible mild side effects. These include redness, warmth, swelling or pain at the injection site, and a fever.

Commonsense precautions

Of course, the Hib vaccine doesn't offer guarantees. Vaccinated children have been known to develop epiglottitis — and other germs can cause epiglottitis, too. That's where commonsense precautions come in:

Don't share personal items.
Wash your hands frequently.
Use an alcohol-based hand sanitizer if soap and water aren't available.

Diagnosis

If the medical team suspects epiglottitis, the first priority is to ensure that your or your child's airway is open and that enough oxygen is getting through. The team will monitor your or your child's breathing and blood oxygen level.

If oxygen saturation levels drop too low, you or your child may need help breathing.

Tests after stabilizing breathing

Throat examination. Using a flexible fiber-optic-lighted tube, the doctor may look down your or your child's throat to see what's causing the symptoms. A local anesthetic can help relieve any discomfort.
Chest or neck X-ray. Because of the danger of sudden breathing problems, children may have X-rays taken at their bedsides rather than in the radiology department — but only after the airway is protected. With epiglottitis, the X-ray may reveal what looks like a thumbprint in the neck, an indication of an enlarged epiglottis.
Throat culture and blood tests. For the culture, the epiglottis is wiped with a cotton swab and the tissue sample is checked for Hib. Blood cultures are usually taken because bacteremia — a severe bloodstream infection — may accompany epiglottitis.

Treatment

Treatment of epiglottitis involves first making sure you or your child can breathe, and then treating any identified infection.

Helping you breathe

The first priority in treating epiglottitis is ensuring that you or your child is receiving enough air. This may mean:

Wearing a mask. The mask delivers oxygen to the lungs.
Having a breathing tube placed into the windpipe through the nose or mouth (intubation). The tube must remain in place until the swelling in your or your child's throat has decreased — sometimes for several days.
Inserting a needle into the trachea (needle cricothyroidotomy). In extreme cases or if more-conservative measures fail, the doctor may need to create an emergency airway by inserting a needle directly into an area of cartilage in your or your child's trachea. This procedure allows air into the lungs while bypassing the larynx.

Treating infection

If your epiglottitis is related to an infection, you will be given intravenous antibiotics.

Broad-spectrum antibiotic. The infection needs quick treatment. So you or your child will likely receive a broad-spectrum drug right away, rather than after your doctor receives the results of the blood and tissue cultures.
More-targeted antibiotic. The initial drug may be changed later, depending on what's causing the epiglottitis.

Preparing for an appointment

Epiglottitis is a medical emergency; you won't have time to prepare for your appointment. The first doctor you'll see will probably be an emergency room physician.