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Epiglottitis

Epiglottitis is inflammation of the epiglottis. This is the tissue that covers the trachea (windpipe). Epiglottitis is a life-threatening disease.

Alternative Names

Supraglottitis

Causes

The epiglottis is a stiff, yet flexible tissue (called cartilage) at the back of the tongue. It closes your windpipe (trachea) when you swallow so food does not enter your airway. This helps prevent coughing or choking after swallowing.

Swelling of the epiglottis is usually caused by the bacteria Haemophilus influenzae (H. influenzae). It may also be due to other bacteria or viruses that can cause upper respiratory infections.

Epiglottitis is now very uncommon because the H. influenzae type B (Hib) vaccine is a routine childhood immunization. The disease was once most often seen in children ages 2 through 6. In rare cases, epiglottitis can occur in adults.

Symptoms

Epiglottitis begins with a high fever and sore throat. Other symptoms may include:

  • Abnormal breathing sounds (stridor )
  • Fever
  • Blue skin color (cyanosis )
  • Drooling
  • Difficulty breathing (patient may need to sit upright and lean slightly forward to breathe)
  • Difficulty swallowing
  • Voice changes (hoarseness)

The airways can become totally blocked, which can result in cardiac arrest and death.

Exams and Tests

Epiglottitis is a medical emergency. Seek immediate medical help. Do not use anything to press the tongue down to try to look at the throat at home. Doing so may make the condition worse.

The health care provider may examine the voice box (larynx) using a small mirror held against the back of the throat. Or a viewing tube called a laryngoscope may be used. This examination is best done in the operating room or a similar setting where sudden breathing problems can be more easily handled.

Tests that may be done include:

Treatment

A hospital stay is needed, usually in the intensive care unit (ICU).

Treatment involves methods to help the person breathe, including:

  • Breathing tube (intubation)
  • Moistened (humidified) oxygen

Other treatments may include:

  • Antibiotics to treat the infection
  • Anti-inflammatory medicines, called corticosteroids, to decrease throat swelling
  • Fluids given through a vein (by IV)

Outlook (Prognosis)

Epiglottitis can be a life-threatening emergency. With proper treatment, the outcome is usually good.

When to Contact a Medical Professional

Spasm may cause the airways to close suddenly. Or, the airways may become totally blocked. Either of these situations could result in death.

Prevention

The Hib vaccine protects most children from epiglottitis.

The most common bacteria (H. influenzae) that causes epiglottitis is contagious. If someone in your family is sick from this bacteria, other family members need to be tested and treated.

References

Burns JE, Hendley JO. Epiglottitis. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 59.

Manno M. Pediatric respiratory emergencies: Upper airway obstruction and infections. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 166.

Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 377.

Updated: 2/25/2014

Sameer Patel, MD, Assistant Professor of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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