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Epiglottitis – Causes, Symptoms and Treatment

Epiglottitis is an acute, potentially life-threatening inflammation of the epiglottis that can cause dangerous narrowing or blockage of the airway.

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Things worth knowing about "Epiglottitis"

Epiglottitis is an acute, potentially life-threatening inflammation of the epiglottis that can cause dangerous narrowing or blockage of the airway.

What is Epiglottitis?

Epiglottitis is an acute inflammation of the epiglottis, the small cartilaginous flap that covers the entrance to the windpipe (trachea) during swallowing to prevent food and liquids from entering the airway. When the epiglottis becomes severely swollen due to infection or injury, it can partially or completely block the airway, making breathing extremely difficult or even impossible. Epiglottitis is a medical emergency requiring immediate medical attention.

Causes

The most common cause of epiglottitis is a bacterial infection. Since the introduction of the Hib vaccine (against Haemophilus influenzae type b), the incidence of epiglottitis in children has decreased dramatically.

Bacteria: Haemophilus influenzae type b (formerly the leading cause in children), Streptococcus pneumoniae, Staphylococcus aureus
Viruses: Herpes simplex virus, Varicella-zoster virus
Fungi: Rare, mainly in immunocompromised individuals
Non-infectious causes: Thermal or chemical injuries (e.g., inhalation of hot steam or caustic substances), physical trauma

Symptoms

Epiglottitis often develops rapidly, sometimes within just a few hours. Common symptoms include:

Severe sore throat and painful swallowing (odynophagia)
Muffled or hot-potato voice
Drooling (because swallowing is too painful)
High fever
Breathing difficulty and stridor (a high-pitched wheezing sound when breathing in)
Tripod positioning: Leaning forward with the neck extended to ease breathing
In advanced cases: cyanosis (bluish discolouration of lips and fingertips) indicating oxygen deprivation

Differences Between Children and Adults

In children, the disease typically progresses faster and is more immediately life-threatening than in adults. The classic presentation of a sick child sitting upright, leaning forward, with an open mouth and drooling is well-recognized. In adults, the progression may be somewhat slower, but epiglottitis remains a serious emergency in all age groups.

Diagnosis

Diagnosis is based on clinical assessment and, where appropriate, imaging. Care must be taken during examination, as manipulation of the throat can trigger laryngospasm and complete airway obstruction.

Clinical examination: Assessment of breathing, throat pain, and swallowing difficulties
Laryngoscopy: Direct visualization of the epiglottis using an endoscope (performed only under controlled, safe conditions)
Neck X-ray: May reveal the characteristic thumbprint sign, indicating a swollen epiglottis
Blood tests: Full blood count, inflammatory markers (CRP, white blood cell count), blood cultures to identify the causative organism

Treatment

Epiglottitis is a medical emergency. Securing the airway is the immediate priority.

Airway Management

In cases of severe breathing difficulty, intubation (insertion of a breathing tube) or, in extreme cases, a tracheotomy (surgical creation of an airway through the neck) may be necessary. These procedures are typically performed in an intensive care setting.

Medical Treatment

Antibiotics: Intravenous broad-spectrum antibiotics (e.g., ceftriaxone) to treat the bacterial infection
Corticosteroids: To reduce swelling (e.g., dexamethasone)
Analgesics and antipyretics: For pain relief and fever management

Prevention

The most effective prevention against the most common form of epiglottitis is the Hib vaccination, recommended as part of standard childhood immunization programmes. Widespread vaccination has led to a dramatic reduction in the incidence of epiglottitis in children worldwide.

References

Sobol SE, Zapata S. Epiglottitis and Croup. Otolaryngologic Clinics of North America, 2008; 41(3): 551-566.
World Health Organization (WHO): Haemophilus influenzae type b (Hib) vaccination position paper. WHO Weekly Epidemiological Record, 2013.
Shah RK, Stocks C. Epiglottitis in the United States: national trends, variances, prognosis, and management. Laryngoscope, 2010; 120(6): 1256-1262.

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