An Overview of Epiglottitis

Epiglottitis is a potentially life-threatening condition that happens when the tissue covering the windpipe becomes swollen. The epiglottis is a small flap of cartilage attached to the end of the tongue that closes off the windpipe, or trachea, when you swallow. A bacterial infection or throat injury can lead to epiglottitis and cause symptoms including pain with swallowing, drooling, and difficulty breathing. By recognizing epiglottitis symptoms early, you can get treatment before it becomes a life-threatening emergency.

Epiglottitis symptoms can start and progress quickly, especially for young children. For older children and adults, it may take a few days for symptoms to completely develop. The most common epiglottitis symptoms include:

• Fever of 100.4 degrees or higher
• Sore throat
• Difficulty and pain when swallowing
• Abnormal breathing noises, possibly high-pitched
• Excessive drooling because of difficulty and pain with swallowing
• Voice that sounds muffled or hoarse
• Irritability and restlessness
• Sitting upright and leaning forward to try to breathe easier

Some of these symptoms can be similar to croup, a respiratory infection that typically occurs in young children. However, croup is usually associated with coughing, not drooling, and epiglottitis is associated with drooling and a lack of coughing. 

The most common cause of epiglottitis is the Haemophilus influenzae type b (Hib) bacteria, which also causes meningitis and pneumonia. With the development of the Hib vaccine, the incidence of this infection has decreased substantially over the last 30 years.  However, cases of epiglottitis continue to occur, either because of Hib or other causes. While the Hib vaccine is 90% to 95% effective, it does not contain all strains of Hib, so it is possible to get Hib and epiglottitis even after being vaccinated.

Other non-Hib causes of epiglottitis include:

• Infections from other bacteria, such as streptococcus pneumoniae, which also causes pneumonia
• Fungal infections, especially in those who have weak immune systems
• Viral infections from the viruses that cause chickenpox or cold sores
• Injury to the throat from hot substances, chemical burns, or foreign objects
• Smoking drugs, such as marijuana and crack cocaine

After a physical examination, your doctor will take X-rays of the neck to view the epiglottis and rule out the possibility of a foreign substance in the airway. Your doctor may also order a flexible laryngoscopy, which uses a long, thin instrument with a small camera at the end to examine the throat. Laboratory tests will be ordered to determine whether the condition is caused by a bacterial infection.

Epiglottitis must be treated in the hospital since it’s considered a medical emergency. The most important step is to keep your airway open. That starts with an oxygen mask to help bring needed air to your lungs. If the oxygen mask isn’t enough, you may be given a tracheal intubation, where a tube is placed down the mouth and into the windpipe to push oxygen past the swollen epiglottis.

In severe cases, a tracheotomy may be performed. This involves making a surgical cut in the front of the windpipe so a tube can be inserted, allowing air to bypass the epiglottis.

Intravenous (IV) fluids will be given until you are able to swallow again. Antibiotics will also be given to help fight the infection that led to epiglottitis.

With appropriate treatment, you should take about a week to recover from epiglottitis.

Vaccinating your kids against Hib is one of the best ways of preventing epiglottitis. While incidences of epiglottitis have decreased, it is still possible to get it through a bacterial infection or throat injury. Epiglottitis does require emergency care, but most people recover fully after receiving timely treatment at the hospital.