17844 Epiglottitis

Overview

Epiglottitis is a rare but serious condition in which the epiglottis — a small flap of tissue at the back of the throat that closes the windpipe when you swallow — becomes swollen and inflamed. Because the epiglottis sits near the airway, severe swelling can make it hard to breathe. It is a medical emergency that needs hospital care right away.

Epiglottitis is rare today, especially in children, thanks to routine vaccines against one of its main causes.

It can affect anyone, but it is most often seen in young children and in adults with weakened immune systems or other long-term health conditions.

Symptoms

Common symptoms

• Severe sore throat that comes on quickly
• High fever
• Painful or difficult swallowing
• Drooling and trouble managing saliva
• A muffled or 'hot potato' voice
• Noisy or difficult breathing
• Feeling very unwell and anxious

Symptoms in children

• Symptoms often appear suddenly and get worse within hours
• The child may refuse to eat or drink
• They may sit leaning forward with their mouth open and tongue out
• They may drool more than usual
• They may be restless, scared, or unusually quiet

Symptoms in older adults

• Symptoms can develop more slowly than in children
• Severe sore throat and trouble swallowing are often the main signs
• Fever may be lower or absent
• Breathing problems can appear later, so it is easy to mistake the condition for a severe throat infection

Causes

Main causes

• Bacterial infection, most commonly Haemophilus influenzae type b (Hib)
• Other bacteria, such as those that cause strep throat or pneumonia
• Viral infections
• Injury to the throat from swallowing a harsh chemical, hot liquid, or a sharp object

Risk factors

• Not being vaccinated against Hib
• Having a weakened immune system
• Being a child between 2 and 5 years old, though it can happen at any age
• Smoking or inhaling irritants
• Using certain illegal drugs that may damage the throat

When to see a doctor

See a doctor urgently if:

• If you or your child have severe throat pain, drooling, a changed voice, or any difficulty breathing, call your local emergency number now.
• Do not try to drive yourself to the hospital — call for an ambulance so you can receive help on the way.

Book a routine appointment if:

• If you have a mild sore throat but no breathing trouble, drooling, or swallowing problems, you can contact your GP practice for advice.
• If you are not sure whether your symptoms are serious, call your local health service for urgent advice.

Diagnosis

A doctor will ask about your symptoms and check your breathing. If they suspect epiglottitis, they will not try to look deep into your throat with a tongue depressor, because that can make swelling worse. Instead, they may use a small flexible camera to look at the epiglottis in a safe, controlled setting, such as an emergency department or operating room.

Tests that may be done

• A flexible nasopharyngoscopy — a thin camera passed through the nose to see the throat
• Pulse oximetry to measure oxygen levels in the blood
• Blood tests to check for infection
• A throat swab or blood culture to identify the cause
• X-ray or CT scan in some cases

What to expect at your appointment

If epiglottitis is suspected, you will not be sent home. You will be admitted to hospital and monitored closely until the swelling goes down and your breathing is safe.

Treatment

Epiglottitis is treated in hospital. The first and most important step is to keep the airway open and make sure you can breathe safely. Doctors will then treat the infection and reduce swelling.

Self-care at home

• Stay calm and sit upright, leaning slightly forward — this can help keep the airway open.
• Do not try to look at your own throat or put anything in your mouth.
• Do not eat or drink until a healthcare professional says it is safe.
• Do not lie flat on your back, as this can make breathing harder.
• Call for emergency help rather than trying to get to hospital on your own.

Medical treatments

In hospital, treatment may include oxygen, fluids given through a vein, antibiotics to fight infection, and medicines to reduce swelling in the airway. If the airway is at risk, a doctor may place a breathing tube to help you breathe until the swelling improves. The exact treatment depends on how severe the swelling is and your overall health.

When is surgery considered?

Most people with epiglottitis do not need surgery. But if the airway becomes severely blocked, doctors may need to place a tube into the windpipe, or rarely make a small opening in the windpipe (a tracheostomy) to help you breathe. This is an emergency, life-saving procedure and is only done when necessary.

Living with this condition

After treatment, most people recover fully. You may need to rest your voice and take it easy for a few days. Your healthcare team will tell you what to watch for and when to seek help if symptoms return.

Lifestyle tips

• Rest and give your body time to heal after leaving hospital.
• Avoid smoking and being around smoke or other irritants that could affect your throat.
• Wash your hands often to reduce the chance of infections.
• Keep your vaccinations up to date.

Diet and exercise

When you are ready to eat and drink again, start with small sips of cool fluids and soft foods if your throat feels sore. Return to exercise gradually, and stop if you feel breathless or unwell.

Mental health and emotional wellbeing

A sudden breathing emergency can be frightening and may stay with you. It is normal to feel anxious, worried, or stressed afterwards. Talk to your GP or care team if these feelings do not go away or affect your daily life.

Prevention

In many cases, yes. Routine vaccination has made epiglottitis much less common. Avoiding throat injury and practicing good hand hygiene also help reduce risk.

Vaccines

The Hib vaccine is the best protection against the most common cause of epiglottitis. Make sure your vaccinations and your children's vaccinations are up to date. Adults with certain health conditions may also be advised to have additional vaccines — ask your doctor or local immunisation service.

Screening programmes

There is no routine screening test for epiglottitis. Prevention focuses on vaccination and seeking early medical care for severe throat infections.

Complications

If left untreated

• Complete blockage of the airway, which can be life-threatening
• Severe breathing failure
• Infection spreading into the blood, known as sepsis
• Pneumonia or other lung infections
• In very rare cases, death

Long-term outlook

With prompt hospital care, the vast majority of people with epiglottitis recover completely and return to their normal lives. Acting quickly is the most important thing you can do.

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