What is Epiglottitis? Symptoms, Causes, & Treatment

Epiglottitis is a serious infection that causes swelling of the epiglottis, a small flap of tissue that covers your windpipe when you swallow. This condition can make breathing and swallowing extremely difficult and requires immediate medical attention.

Think of your epiglottis as a protective lid that prevents food and liquids from entering your lungs. When it becomes inflamed and swollen, it can partially or completely block your airway, creating a medical emergency that needs prompt treatment.

What is Epiglottitis?

Epiglottitis occurs when the epiglottis becomes infected and swells up significantly. The epiglottis is a leaf-shaped piece of cartilage located at the base of your tongue, just above your voice box.

This condition was once primarily seen in children, but vaccination against Haemophilus influenzae type b (Hib) has dramatically reduced childhood cases. Today, epiglottitis affects adults more commonly than children, though it can still occur at any age.

The swelling happens quickly and can progress rapidly within hours. Because the epiglottis sits right at the entrance to your airway, even small amounts of swelling can cause serious breathing problems.

What are the Symptoms of Epiglottitis?

The symptoms of epiglottitis develop rapidly and can become severe within hours. Recognizing these signs early can be lifesaving, as the condition can quickly compromise your ability to breathe.

The most common symptoms include:

• Severe sore throat that comes on suddenly
• Difficulty swallowing, often with drooling
• Muffled or hoarse voice
• High fever, typically above 101°F (38.3°C)
• Trouble breathing or noisy breathing
• Preference for sitting upright and leaning forward

In children, you might also notice irritability, restlessness, and a tendency to keep their mouth open to breathe better. Adults may experience less dramatic symptoms initially, but the condition can still progress quickly.

The hallmark sign is the tripod position, where someone sits upright, leans forward, and extends their neck to make breathing easier. This position helps open the airway as much as possible.

What Causes Epiglottitis?

Epiglottitis is primarily caused by bacterial infections, though viruses and other factors can also trigger the condition. Understanding the causes helps explain why prompt antibiotic treatment is so important.

The most common bacterial causes include:

• Streptococcus pneumoniae (pneumococcus)
• Streptococcus pyogenes (group A strep)
• Staphylococcus aureus
• Haemophilus influenzae type b (now rare due to vaccination)

Less common causes can include viral infections like those causing colds or flu, fungal infections in people with weakened immune systems, or physical injury to the throat from very hot liquids or direct trauma.

Sometimes, chemical burns from inhaling smoke, steam, or other irritating substances can cause similar swelling. Drug use, particularly smoking crack cocaine, has also been linked to epiglottitis in some cases.

When to See a Doctor for Epiglottitis?

Epiglottitis is always a medical emergency that requires immediate hospital care. If you suspect epiglottitis in yourself or someone else, call 911 or go to the emergency room right away.

Seek emergency medical care immediately if you notice:

• Sudden, severe sore throat
• Difficulty breathing or swallowing
• Drooling due to inability to swallow
• Muffled voice or inability to speak clearly
• High fever with throat symptoms
• Sitting in the tripod position

Don't wait to see if symptoms improve on their own. The airway can become completely blocked within hours, which can be fatal without immediate medical intervention.

Avoid trying to look into the throat with a flashlight or tongue depressor, as this can cause the swollen epiglottis to completely block the airway. Let medical professionals handle the examination with proper equipment.

What are the Risk Factors for Epiglottitis?

While epiglottitis can affect anyone, certain factors can increase your risk of developing this serious condition. Being aware of these risk factors helps you stay vigilant for symptoms.

The main risk factors include:

• Being male (affects men more than women)
• Having a weakened immune system
• Not being vaccinated against Hib
• Living in crowded conditions
• Having diabetes or other chronic conditions
• Being of African American ethnicity (slightly higher risk)

Age also plays a role, with adults between 20 and 40 years old being most commonly affected today. However, the condition can occur at any age, and elderly individuals may be at higher risk due to generally weaker immune systems.

Certain activities or exposures can also increase risk, such as smoking, excessive alcohol use, or exposure to secondhand smoke. People who work in environments with chemical fumes or irritants may also face elevated risk.

What are the Possible Complications of Epiglottitis?

Epiglottitis can lead to serious, life-threatening complications if not treated promptly. The most dangerous complication is complete airway obstruction, which can be fatal within minutes.

The most serious complications include:

• Complete airway blockage requiring emergency breathing tube
• Respiratory failure and cardiac arrest
• Spread of infection to other parts of the body
• Pneumonia from aspirating saliva or food
• Blood infection (sepsis)

In rare cases, the infection can spread to nearby tissues, causing abscesses in the throat or chest. This can lead to further breathing difficulties and may require surgical drainage.

The good news is that with prompt recognition and appropriate treatment, most people recover completely from epiglottitis. The key is getting medical care before serious complications develop.

How is Epiglottitis Diagnosed?

Diagnosing epiglottitis requires careful medical evaluation, as examining the throat incorrectly can be dangerous. Emergency room doctors use specific techniques and equipment to safely assess the condition.

The diagnostic process typically involves taking a detailed history of symptoms and their onset. Doctors will ask about fever, sore throat, difficulty swallowing, and breathing problems while keeping you as calm and comfortable as possible.

To visualize the epiglottis safely, doctors may use a flexible scope called a laryngoscope that goes through your nose. This allows them to see the swollen epiglottis without triggering airway spasm or complete obstruction.

In some cases, a lateral neck X-ray can show the swollen epiglottis, appearing as what doctors call the "thumbprint sign." However, this is only done if the patient is stable and can lie flat safely.

Blood tests may be performed to identify the specific bacteria causing the infection and check for signs of widespread infection. These tests help guide antibiotic selection and monitor your overall condition.

What is the Treatment for Epiglottitis?

Treatment for epiglottitis focuses on two main goals: securing your airway to ensure you can breathe safely and fighting the infection with antibiotics. This always happens in a hospital setting with close monitoring.

The first priority is airway management. If breathing is severely compromised, doctors may need to insert a breathing tube through your mouth or perform a tracheostomy, which creates a temporary opening in your neck for breathing.

Antibiotic treatment typically involves intravenous medications that can effectively fight the most common bacteria causing epiglottitis. The specific antibiotic choice depends on local bacterial resistance patterns and your individual health factors.

Supportive care includes:

• Oxygen therapy to help with breathing
• IV fluids to prevent dehydration
• Pain medication and fever reducers
• Corticosteroids to reduce swelling
• Humidified air to soothe inflamed tissues

Most people start feeling better within 24 to 48 hours of starting appropriate treatment. However, hospital stays typically last several days to ensure the infection is fully controlled and breathing remains stable.

How to Take Home Care During Epiglottitis Recovery?

Home care for epiglottitis only begins after you've been treated in the hospital and your doctor determines it's safe for you to go home. Recovery continues for several days to weeks after discharge.

During recovery at home, it's important to complete your full course of oral antibiotics, even if you're feeling much better. Stopping antibiotics early can allow the infection to return or lead to antibiotic resistance.

To support your recovery:

• Get plenty of rest to help your body fight the infection
• Drink warm liquids like broth or tea with honey
• Use a humidifier to keep throat tissues moist
• Take pain relievers as recommended by your doctor
• Avoid smoking and secondhand smoke completely

Watch for any return of symptoms like difficulty swallowing, breathing problems, or high fever. Contact your doctor immediately if any of these symptoms reappear, as they could indicate the infection is returning.

Most people can return to normal activities within a week or two, but follow your doctor's specific recommendations about when it's safe to resume work, exercise, or other regular activities.

How Should You Prepare for Your Doctor Appointment?

If you're experiencing symptoms of epiglottitis, this is not a condition for a regular doctor appointment. Instead, you need immediate emergency medical care at a hospital emergency room.

However, if you're following up after treatment or have concerns about epiglottitis risk, here's how to prepare for a medical consultation:

Before your appointment, write down all your symptoms, including when they started and how they've changed. Note any recent illnesses, vaccinations, or exposures that might be relevant.

Prepare a list of all medications you take, including over-the-counter drugs and supplements. Also, gather information about your vaccination history, particularly Hib and pneumococcal vaccines.

Think about questions you want to ask, such as your risk factors, prevention strategies, or what symptoms would require immediate medical attention in the future.

How Can Epiglottitis Be Prevented?

Prevention of epiglottitis centers around vaccination and good hygiene practices. The dramatic reduction in childhood epiglottitis cases shows how effective prevention strategies can be.

The most important prevention tool is staying up to date with vaccinations. The Hib vaccine has nearly eliminated Haemophilus influenzae type b as a cause of epiglottitis in children and adults.

Other recommended vaccines include:

• Pneumococcal vaccine to prevent Streptococcus pneumoniae infections
• Annual flu vaccine to reduce viral infections that can lead to secondary bacterial infections
• COVID-19 vaccination to prevent respiratory infections

Good hygiene practices can help prevent the spread of bacteria and viruses that cause epiglottitis. This includes washing your hands frequently, avoiding close contact with sick people, and not sharing eating utensils or drinks.

If you have risk factors like diabetes or a weakened immune system, work with your healthcare provider to manage these conditions effectively. This can help reduce your overall infection risk.

What's the Key Takeaway About Epiglottitis?

Epiglottitis is a serious but treatable medical emergency that affects the small flap of tissue protecting your airway. The most important thing to remember is that symptoms can develop rapidly and require immediate medical attention.

Never ignore sudden, severe throat pain, especially when combined with difficulty swallowing, breathing problems, or high fever. These symptoms warrant an immediate trip to the emergency room, not a wait-and-see approach.

The good news is that with prompt medical care, most people recover completely from epiglottitis. Modern antibiotics and airway management techniques have made this once-feared condition highly treatable when caught early.

Prevention through vaccination remains your best defense against epiglottitis. Stay current with recommended vaccines and maintain good hygiene practices to reduce your risk of developing this serious infection.