Epiglottitis is inflammation and swelling of the epiglottis. In most cases, it’s caused by infection.
The epiglottis is a flap of tissue that sits beneath the tongue at the back of the throat. Its main function is to close over the windpipe (trachea) while you’re eating, to prevent food entering your airways.
Symptoms of epiglottitis
The symptoms of epiglottitis usually develop quickly and get rapidly worse, although they can develop over a few days in older children and adults. Symptoms include:
- a severe sore throat
- difficulty and pain when swallowing
- difficulty breathing, which may improve when leaning forwards
- breathing that sounds abnormal and high-pitched (stridor)
- a high temperature (fever) of 38C (100.4F) or above
- irritability and restlessness
- muffled or hoarse voice
The main symptoms of epiglottitis in young children are breathing difficulties, stridor and a hoarse voice. In adults and older children, the main signs are a severe sore throat, swallowing difficulties and drooling.
When to seek medical advice
Epiglottitis is regarded as a medical emergency, as a swollen epiglottis can restrict the oxygen supply to your lungs.
Dial 999 to ask for an ambulance if you think you or your child has epiglottitis.
While waiting for an ambulance, you shouldn’t attempt to examine your child’s throat, place anything inside their mouth or lay them on their back, because this may make their symptoms worse. It’s important to keep them calm and to try not to cause panic or distress.
Epiglottitis can be fatal if the throat becomes completely blocked. However, with appropriate treatment, most people make a full recovery.
Epiglottitis is treated in hospital. The first thing the medical team will do is to secure the airways, to make sure the affected person can breathe properly.
Once this has been achieved and the situation is thought to be safe, some tests may be carried out, such as:
- a fibre-optic laryngoscopy – a procedure that uses a flexible tube with a camera attached to one end (laryngoscope) to examine your throat
- a throat swab – to test for any bacteria or viruses
- blood tests – to check the number of white blood cells (a high number indicates there may an infection) and to identify any traces of bacteria or viruses in the blood
- an X-ray or a computerised tomography (CT) scan – sometimes used to check the level of swelling
The underlying infection will be treated with a course of antibiotics, and most people with epiglottitis are well enough to leave hospital after five to seven days.
Read more about treating epiglottitis.
Why it happens
Epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria. As well as epiglottitis, Hib can cause a number of serious infections, such as pneumonia and meningitis.
It spreads in the same way as the cold or flu virus; the bacteria are in the tiny droplets of saliva and mucus propelled into the air when an infected person coughs or sneezes. You catch the infection by breathing in these droplets or, if the droplets have landed on a surface or object, by touching this surface and then touching your face or mouth.
Less common causes of epiglottitis include:
- other bacterial infections – such as streptococcus pneumoniae (a common cause of pneumonia)
- fungal infections – people with a weakened immune system are most at risk from these types of infection
- viral infections – such as the varicella zoster virus (the virus responsible for chickenpox) and the herpes simplex virus (the virus responsible for cold sores)
- trauma to the throat – such as a blow to the throat, or burning the throat by drinking very hot liquids
- smoking – particularly illegal drugs, such as cannabis or crack cocaine
The most effective way to prevent your child getting epiglottitis is to make sure their vaccinations are up to date.
Children are particularly vulnerable to a Hib infection, because they have an underdeveloped immune system.
Children should receive three doses of the vaccine: one at two months, one when they are three months and one when they are four months old. This is followed by an additional Hib/Men C “booster” vaccine at 12 months.
As children from developing countries may not have received the vaccination, children who have immigrated to the UK should take part in the UK immunisation programme. Contact your GP if you are not sure whether your child’s vaccinations are up to date.
Read more about the childhood vaccination schedule.
Who is affected
Because of the success of the Hib vaccination programme, epiglottitis is rare in the UK, and most cases now occur in adults. Deaths from epiglottitis are also rare, occurring in less than 1 in 100 cases.
During 2013-14, around 600 people were admitted to hospitals in England with acute epiglottitis.
Epiglottitis is a medical emergency that requires immediate treatment and admission to the nearest hospital.
The first priority in treating epiglottitis is to make the person is able to breathe. This is known as securing the airways.
Securing the airways
Your care team will initially try to improve your breathing by using an oxygen mask that delivers highly concentrated oxygen to your lungs.
If this doesn’t work, a tube will be placed in your mouth and pushed past your epiglottis into your windpipe. The tube will be connected to an oxygen supply.
In severe cases, where there’s an urgent need to secure the airways, a small cut may be made in your neck, at the front of your windpipe, so a tube can be inserted. The tube is then connected to an oxygen supply. This procedure is called a tracheostomy and it allows oxygen to enter the lungs while bypassing the epiglottis. An emergency tracheostomy can be carried out using local anaesthetic or general anaesthetic.
Once the airways have been secured and you’re able to breathe unrestricted, a more comfortable and convenient way of assisting your breathing may be found. This is usually achieved by threading a tube through the nose and into the windpipe.
Fluids will be supplied through a drip into one of your veins, until you’re able to swallow.
Treating the infection
Once the affected person is able to breathe unrestricted, the source of the infection will be treated. As most cases of epiglottitis are caused by a bacterial infection, injections of broad spectrum antibiotics will be used.
Broad spectrum antibiotics are designed to treat a wide range of bacterial infections. Once the type of infection has been identified, a more specific type of antibiotic may be used.
Most people will need to take antibiotics for several days. As your symptoms improve, you may be given antibiotic tablets, capsules or liquids (oral antibiotics), rather than injections.
With prompt treatment, most people recover from epiglottitis after about a week and are usually well enough to leave hospital after five to seven days.