Epiglottitis

What is epiglottitis?

Epiglottitis (pronounced “eh-pih-glah-tai-tis”) is inflammation and swelling of your epiglottis. Your epiglottis is a thin flap of cartilage near the base of your tongue. It keeps food and liquids from going down your windpipe (trachea) when you swallow.

You may also hear the term “acute epiglottitis.” This refers to the very sudden and intense onset of symptoms, including difficulty breathing and swallowing. Without prompt treatment, the swelling can block your airway and even be fatal.

It’s essential to get to the emergency room (ER) immediately if you or a loved one is experiencing symptoms of epiglottitis. Epiglottitis is a medical emergency that you should never try to manage at home.

How common is this condition?

Epiglottitis is an uncommon condition that affects both children and adults.

Before the widespread use of Haemophilus influenzae (Hib) vaccinations in 1985, epiglottitis mainly affected children between the ages of 3 and 5. Thanks to the vaccine, cases of Hib infection —the primary cause in children — have fallen. Now, only .5 out of every 100,000 children in the U.S. get epiglottitis.

But cases have been on the rise in adults. Most are related to infections other than Hib. Epiglottitis affects anywhere from 1 to 4 out of every 100,000 adults in the U.S.

What are the signs and symptoms of epiglottitis?

Epiglottitis symptoms usually appear suddenly and get worse quickly. Sometimes, in older children and adults, it may take a few days for symptoms to develop fully. But in young children, who have smaller airways, a swollen epiglottis often causes severe symptoms that appear without warning.

The most common symptoms include:

1. Dysphagia: Difficulty swallowing
2. Dysphonia: Hoarseness or an abnormal voice
3. Drooling: Saliva (spit) flowing out of your mouth involuntarily
4. Distress: Difficulty breathing or lack of oxygen

Other epiglottitis symptoms include:

• Severe sore throat
• Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
• A high-pitched whistling sound when you breathe
• An open mouth and leaning forward to breathe (a main symptom in young children)
• Irritability and restlessness (a main symptom in young children)

Epiglottitis shares several common symptoms with other conditions, such as croup. But unlike epiglottitis, croup doesn’t always require emergency treatment. This is why proper diagnosis and treatment are key.

What causes epiglottitis?

Bacterial infections are the most common cause of epiglottitis. In children, Haemophilus influenzae type b (Hib) bacteria is the most common cause. In adults, bacterial infections usually come from non-Hib sources. These include Streptococcus pneumoniae and Staphylococcus bacteria.

Other possible epiglottitis causes include:

• Viral infections. Viruses like varicella-zoster virus and herpes simplex virus can make you vulnerable to bacterial infections that may lead to epiglottitis.
• Fungal infections. Candida infections, particularly in people with a weak immune system, have been linked to epiglottitis.
• Injury to your throat. The injury may involve things like a physical blow, swallowing a foreign object or drinking a very hot liquid.
• Smoking. This includes vaping or smoking substances like crack cocaine.
• Chemical burns. Epiglottitis can develop from ingesting a harmful chemical. This is called corrosive epiglottitis.

Is epiglottitis contagious?

Getting an infection that can cause epiglottitis — like Hib — doesn’t mean you’ll develop epiglottitis, too. But you may if the germ spreads to your epiglottis and causes inflammation. The offending germs can spread from person to person through droplets of saliva or mucus when they cough or sneeze.

How is epiglottitis diagnosed?

Since epiglottitis is a life-threatening medical emergency, healthcare providers usually work through the steps of making a diagnosis only after they’ve stabilized your breathing.

Once you’re stable (and only if it’s perfectly safe), they may run the following tests to diagnose epiglottitis:

• Culture tests. A provider swabs your throat and sends the sample to a pathology lab to test for bacteria or viruses.
• Blood tests. Your provider may perform a variety of blood tests to count your white blood cells (your body’s infection-fighters) or see if there are any bacteria or viruses in your blood.
• Laryngoscopy. A provider uses a small camera at the end of a flexible tube to examine your throat.
• Imaging tests. An X-ray can help determine the level of swelling. Epiglottic swelling on an X-ray sometimes resembles an adult thumb. Providers sometimes call this the “thumbprint sign.”

How is epiglottitis treated?

You’ll receive treatment for epiglottitis immediately. In the hospital, your care team will:

1. Restore your airways to full capacity. Your healthcare provider will place an oxygen mask over your mouth and nose so your lungs can get more air. If your air passages are blocked, they may place a breathing tube through your mouth and into your windpipe. (If your provider can’t insert a breathing tube through your mouth, they may need to insert a breathing tube through your neck. This is called a tracheostomy. But it’s rare that people with epiglottitis need this.)
2. Administer fluids. Your medical team will give you plenty of fluids through an intravenous (IV) drip (a needle inserted into a vein).
3. Administer antibiotics. If you have a bacterial infection, your provider will give you a broad-spectrum antibiotic through an IV. This medicine kills most strains of bacteria that may be causing the infection. Once your provider gets the results of your culture tests, they may give you a different antibiotic that targets the specific bacteria causing your infection.

How can I prevent epiglottitis?

You can’t prevent an inflamed epiglottis altogether, but there are things you can do to reduce the risk:

• Get your child vaccinated. In children, the best prevention is to ensure all their childhood immunizations are up to date. Children are especially vulnerable to Hib infections because their immune systems haven’t fully developed yet.
• Practice good hygiene. Wash your hands frequently, and avoid placing fingers in your eyes, nose and mouth.
• Protect yourself from infection. Take precautions around people who are coughing and sneezing, like avoiding close contact or masking up.
• Avoid injury to your throat. Steer clear of activities that can damage your throat, like drinking hot liquids or smoking.

What can I expect if I have epiglottitis?

For most people, it takes about one week to fully recover from epiglottitis. You’ll probably spend between three to five days in the hospital. But you may start to feel better within the first few days. Even if you get a breathing tube, it usually only takes a few days before you’re able to breathe on your own.

If an infection causes your condition, it’s important to take the full course of antibiotics to kill the bacteria (usually about seven days).

When addressed quickly, treatment can heal epiglottitis. Still, it’s important to remember that an inflamed epiglottis is a medical emergency. If you or someone you know exhibits epiglottitis symptoms, call 911 (or your local emergency services number) or head to your nearest emergency room.

When should I see my healthcare provider?

Epiglottitis can be life-threatening if swelling closes off your airway. If you think you or someone you know might have a swollen epiglottis, seek emergency care immediately.

Never put anyone with epiglottitis on their back or allow them to have anything in their mouth. This can make it even harder for someone with the condition to breathe. Also, try to remain calm, as stress can worsen the tightening of someone’s throat.

What questions should I ask my healthcare provider?

Questions to ask before leaving the hospital include:

• What caused my epiglottitis?
• How long will I need to continue taking antibiotics?
• How can I care for my throat during recovery?
• How long should I avoid lying down (on my back)?
• Will I need follow-up visits?
• How can I reduce my risk of epiglottitis in the future?