Epiglottitis

Overview

Epiglottitis is swelling of the epiglottis. The epiglottis is a small flap at the back of the throat that helps keep food and drink out of the airway. When it swells, it can block breathing. This is a medical emergency, so get help right away if you think someone may have it.

Epiglottitis is uncommon now in places where Hib vaccination is routine, but it still happens. It can affect anyone at any age.

It used to be most common in young children. Now it is more often seen in adults, but children can still get it. People who are not vaccinated against Hib, have a weak immune system, or smoke may be at higher risk.

Symptoms

Common symptoms

• Fever
• Severe sore throat
• Painful or impossible swallowing
• Drooling
• Muffled voice
• Noisy breathing
• Fast breathing
• Leaning forward to breathe more easily
• Restlessness or anxiety

Symptoms in children

• High fever
• Drooling
• Refusing to eat or drink
• Irritability
• Sitting forward with the chin out
• Muffled cry
• Rapid breathing
• Blue or grey lips

Symptoms in older adults

• Severe sore throat
• Fever
• Trouble swallowing
• Voice change
• Breathing trouble, even if drooling is less obvious

Causes

Main causes

• Infection with bacteria or viruses
• Hib bacteria is a major cause in people who are not vaccinated
• Rarely, injury, burns, or irritation from smoking

Risk factors

• Not being vaccinated against Hib
• Being a young child
• Being an older adult
• Having a weak immune system
• Smoking or being around tobacco smoke

When to see a doctor

See a doctor urgently if:

• Call your local emergency number if there is any trouble breathing, drooling, blue lips, or inability to swallow
• Get same-day urgent care for a severe sore throat with fever and a changing voice, especially if symptoms are getting worse quickly
• Do not try to look in the throat at home or put anything in the mouth

Book a routine appointment if:

• Ask your doctor or pharmacist about Hib vaccination if you are unsure of your vaccination status
• See a doctor for a mild sore throat only if there is no trouble breathing, swallowing, or voice change

Diagnosis

A doctor may suspect epiglottitis from the symptoms and how quickly they appear. Because the airway can close, diagnosis and care usually happen in an emergency setting.

Tests that may be done

• Laryngoscopy: a specialist uses a thin camera to look at the epiglottis
• Blood tests
• X-ray or CT scan
• Throat swab or culture, but only after the airway is safe

What to expect at your appointment

You or your child will be seen in an emergency setting. Staff will focus on breathing first. They may avoid a full throat exam until the airway is protected, because pressing on the throat can make swelling worse. A specialist may use a camera to look at the epiglottis.

Treatment

Epiglottitis is treated in hospital as an emergency. The first goal is to protect the airway and breathing.

Self-care at home

• Only after a doctor says it is safe to go home
• Rest your voice
• Drink fluids and eat soft foods while the throat heals
• Take medicines exactly as prescribed
• Avoid smoking and vaping
• Keep follow-up appointments
• Make sure vaccinations are up to date

Medical treatments

Treatment may include oxygen, fluids, close monitoring, medicines to fight infection, and medicines to reduce swelling. Some people need help with breathing for a short time. Care is given by a specialist team in hospital.

When is surgery considered?

Surgery is not usually needed. In rare cases, a specialist may need to drain an abscess or place a temporary breathing tube if the airway is blocked.

Living with this condition

Most people recover fully after treatment. Follow your doctor's advice about rest and follow-up. Watch for breathing problems, and get help right away if they return.

Lifestyle tips

• Avoid smoking and secondhand smoke
• Wash hands often
• Keep Hib vaccination up to date
• Get plenty of rest while recovering

Diet and exercise

Start with fluids and soft foods if the throat is sore. Return to gentle activity as you feel better. Avoid strenuous exercise until you have recovered and your doctor says it is safe.

Mental health and emotional wellbeing

A serious breathing illness can be frightening for patients and families. Anxiety, poor sleep, or bad dreams are common after a scary health event. Talk with your doctor if these feelings continue. If you feel overwhelmed or have thoughts of harming yourself, contact your local emergency or crisis service right away.

Prevention

You can lower the risk with Hib vaccination, good hand hygiene, and avoiding smoking and secondhand smoke.

Vaccines

The Hib vaccine is part of routine childhood schedules in many countries. Adults with risk factors should ask their doctor whether they need it.

Screening programmes

There is no routine screening test for epiglottitis.

Complications

If left untreated

• Airway blockage and breathing failure
• Low oxygen levels
• Spread of infection to the blood or lungs
• Abscess in the throat
• Life-threatening illness

Long-term outlook

With quick treatment, most people recover fully. Some need breathing support for a short time. Getting emergency help fast makes a big difference.

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