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 secure the person's airways, to make sure they can breathe properly.
Securing the airways
An oxygen mask will be given to deliver highly concentrated oxygen to the person's lungs.
If this doesn't work, a tube will be placed in the patient's mouth and pushed past their epiglottis into the 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 the neck, at the front of the 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 the person is able to breathe unrestricted, a more comfortable and convenient way of assisting 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 the person is able to swallow.
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 flexible tube with a camera attached to one end (laryngoscope) is used to examine the 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 then be treated with a course of antibiotics, and most people with epiglottitis are well enough to leave hospital after five to seven days.
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.
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 their Hib as part of the 5 in 1 DTaP/IPV/Hib vaccine, which also protects against diphtheria, tetanus, whooping cough and polio.
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.