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Epiglottitis
Epiglottitis is the term used to describe inflammation and swelling of the epiglottis which lies just behind the root of your tongue. It is usually caused by a viral or bacterial infection. The usual symptoms are fever, sore throat and difficulty swallowing. Breathing dififculties can occur. Prompt treatment is needed to ensure that enough oxygen can reach the lungs, and includes antibiotics. If epiglottitis is treated quickly, the outlook is generally very good. Untreated, it can be life-threatening. Since immunisation against Hib was introduced, the number of children who develop epiglottitis in the UK has reduced dramatically.

What is the epiglottis?

The epiglottis is a leaf-shaped flap of cartilage tissue that lies just behind the root of your tongue. When you swallow, your epiglottis covers your larynx ( voicebox) stopping food from entering your trachea (windpipe. Your larynx is in the front of your neck above your trachea. It contains your vocal cords and also allows air to pass from your mouth into your trachea, and from there to your lungs.

What is epiglottitis and what causes it?

Epiglottitis is inflammation of the epiglottis. It is almost always caused by a bacterial infection. The most common bacterium that causes epiglottitis is Haemophilus influenzae type b (Hib). Other bacteria such as Streptococcus pneumoniae can also cause epiglottitis.

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Infection leads to inflammation and swelling of the epiglottis. If the epiglottis swells, because of its position in your throat, it can affect your breathing by obstructing (blocking) the passage of air through your larynx to your trachea and your lungs. Epiglottitis can be confused for croup which is a common childhood viral infection affecting the larynx (voice box) and trachea (windpipe). Croup is less dangerous than epiglottitis and improves on its own. See separate leaflet called Croup for more detail.

Who gets epiglottitis and how common is it?

Epiglottitis can occur at any age but it most commonly affects children between the ages of two and seven. However, since the Hib vaccine was introduced in the UK and other countries in the 1990s, the numbers of children who develop epiglottitis have reduced dramatically. It is now rare. As the use of the Hib vaccine increases, this has meant that the typical person who develops epiglottitis is an adult rather than a child. However, it is still rare for adults to get epiglottitis. You are more at risk if your immune system does not work properly; for example, if you have had chemotherapy or if you have HIV. Also, no vaccine is 100% effective. So, rarely, epiglottitis caused by Hib can occur even in someone who has been vaccinated against Hib.

What are the symptoms of epiglottitis?

Fever (high temperature) is usually the first symptom. Someone with epiglottitis will also complain of a very sore throat. They may have a hoarse voice and pain on swallowing. Because of the pain on swallowing, they may drool saliva. Coughing is a less common symptom. Noisy breathing and breathing difficulty then follow and need to be treated quickly. Someone with epiglottitis usually prefers to sit upright and lean slightly forwards, often with their tongue protruding (sticking out). This position helps to open up their airway to let more oxygen through to the lungs. Someone with epiglottitis can be quite scared and panicked. You may hear a grunting noise as they try to breathe. As less oxygen gets through to the lungs, their skin colour can change and can become grey or blue. If treatment is not started quickly, the swelling of the epiglottis can totally obstruct (block) the airway. This means that air is not able to reach the lungs and this can cause collapse and death. In general, adults with epiglottitis tend to have less severe symptoms than children and the symptoms tend to develop more slowly.

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How is epiglottitis diagnosed?

If someone has suspected epiglottitis, they should be admitted to hospital immediately. It should be treated as an emergency by calling 999 for an ambulance. Do not lay the person down or try to look in their throat, as this can cause the throat to close off completely and may cause breathing to stop altogether. Epiglottitis is usually diagnosed by the typical symptoms. A procedure called a nasopharyngoscopy may be used, once you are in hospital, to help confirm epiglottitis. A thin flexible tube is run down your nose into your throat. The doctor is able to see through the tube and look for swelling or redness of the epiglottis. Sometimes an X-ray of your neck is taken and this can show a swollen epiglottitis. A swab is also usually taken from your throat and sent to the laboratory to look for infection. A blood sample may also be taken, again to look for signs of infection.

What is the treatment for epiglottitis?

If someone has epiglottitis, the most important treatment is to ensure that they are getting enough oxygen into their lungs. For example, oxygen can be given using a mask over their mouth and nose. Sometimes someone may need help with their breathing, using a ventilator (a machine that is mechanically operated to maintain the flow of oxygen and air into and out of the lungs). In severe cases, if the epiglottis is swollen and blocking the airway, even if oxygen is given, it would not be able to reach the lungs. So, a procedure called a tracheostomy is done. This is where a small cut is made in the trachea (windpipe). This allows a tube to pass below the swollen epiglottis so that oxygen can be delivered to the lungs. Someone with a tracheostomy may also need help with their breathing using a ventilator. Antibiotics are another important part of the treatment. They help to fight the infection. A steroid medicine may also be given to help reduce the inflammation around the epiglottis. If someone with epiglottitis is having trouble with their breathing and they need to be ventilated or need a tracheostomy, they will usually be transferred to an intensive care unit. They will be kept on the ventilator until the antibiotics have started to work and the inflammation of the epiglottis has had time to improve.

Are there any complications of epiglottitis?

If epiglottitis is not treated quickly, the airway can become totally blocked. This means that air is not able to get into the lungs and the person can die. However, if epiglottitis is treated quickly, the outlook is generally very good. Recovery usually takes about seven days in children and may be a little longer in adults.

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Rarely, infection can spread from the epiglottis to other parts of the body, including the ear, the brain, the heart and the lungs.

Can epiglottitis be prevented?

The Hib vaccine is advised for all babies at age two, three, four and 12 months. This has led to a dramatic reduction in cases of epiglottitis in children. However, as with all vaccines, it is not always 100% effective. Epiglottitis may also be caused by other bacteria. Close contacts of someone who has been diagnosed with epiglottitis (for example, people who live in the same household) are also usually given antibiotics to help to reduce the chance of them developing the infection.

Further reading & references

Price IM, Preyra I, Fernandes CM, et al; Adult epiglottitis: a five-year retrospective chart review in a major urban centre. CJEM. 2005 Nov;7(6):387-90. McVernon J, Trotter CL, Slack MP, et al; Trends in Haemophilus influenzae type b infections in adults in England and Wales: surveillance study. BMJ. 2004 Sep 18;329(7467):655-8. Tolan Jr RW et al; Pediatric Epiglottitis, Medscape, Jul 2011 Gompf SG et al; Epiglottitis, Medscape, Jul 2011 Original Author: Dr Michelle Wright Last Checked: 05/11/2012 Current Version: Dr Ann Robinson Document ID: 12399 Version: 2 Peer Reviewer: Prof Cathy Jackson EMIS

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