Epiglottitis: Overview, Symptoms, and Treatment

What is Epiglottitis?

Epiglottitis is a life-threatening condition characterised by inflammation of the epiglottis, the flap of tissue at the base of the tongue that prevents food and liquids from entering the windpipe (trachea). Swelling of the epiglottis can rapidly obstruct the
airway, leading to respiratory distress.

It is a medical emergency that requires urgent recognition and treatment.

 

Causes:

Epiglottitis is usually caused by bacterial infection, most commonly:

Haemophilus influenzae type B (Hib) (more common in unvaccinated individuals)

Streptococcus pneumoniae

Streptococcus pyogenes

Staphylococcus aureus (including MRSA)

Other causes include:

Thermal injuries (e.g., hot liquid burns to the throat)

Chemical exposure

Trauma to the throat

 

Symptoms to Watch For

Epiglottitis progresses rapidly, and early recognition is crucial. The classic symptoms include:

1 - In Children (usually age 2-6):

High fever

Severe sore throat

Drooling (due to inability to swallow)

Stridor (high-pitched breathing sound)

Difficulty breathing (often sitting upright and leaning forward – tripod position)

Muffled or weak voice

2 - In Adults:

Severe sore throat with minimal visible redness

Painful swallowing (odynophagia)

Hoarseness or loss of voice

Difficulty breathing (sometimes less dramatic than in children)

🛑 Red Flags (Seek Immediate Medical Help!):

Rapidly worsening symptoms

Drooling and inability to swallow

Difficulty breathing or stridor

Cyanosis (bluish skin due to lack of oxygen)

 

Diagnosis

Diagnosis is clinical but confirmed with investigations:

Direct visualisation of a swollen, cherry-red epiglottis (only in a controlled setting due to airway risk).

Lateral neck X-ray: "Thumb sign" (enlarged epiglottis).

Flexible fibreoptic laryngoscopy (in adults with stable airways).

Blood cultures and throat swabs (after airway stabilization) to identify the causative bacteria.

 

Treatment:

Immediate Airway Management:

Do NOT attempt throat examination with a tongue depressor in children (risk of airway collapse).

Endotracheal intubation (if necessary) or emergency tracheostomy/cricothyrotomy if the airway is obstructed.

Medical Treatment:

IV Broad-Spectrum Antibiotics (targeting H. influenzae, S. pneumoniae, S. aureus):

Ceftriaxone or Cefotaxime (first-line)

Vancomycin (if MRSA is suspected)

Corticosteroids (e.g., dexamethasone) to reduce inflammation

IV fluids (if unable to swallow)

Oxygen therapy if needed

Prevention

Hib Vaccine (Haemophilus influenzae type B) – part of routine childhood immunization in the UK and many countries.

 

References:

NICE Guidelines: Acute Epiglottitis Management –
NICE.org.uk

BMJ Best Practice: Epiglottitis – BMJ Best Practice

CDC: Haemophilus influenzae Infections – CDC.gov

Resuscitation Council UK: Airway Emergencies – Resus.org.uk