Epiglottitis

Overview

Epiglottitis happens when the epiglottis — a small cartilage "lid" that covers the windpipe — swells. The swelling blocks the flow of air into the lungs. Epiglottitis can be deadly.

Many factors can cause the epiglottis to swell. These factors include infections, burns from hot liquids and injuries to the throat.

Epiglottitis can happen at any age. Once, mainly children got it. The most common cause of epiglottitis in children was infection with Haemophilus influenzae type b (Hib) bacteria. The bacterium also causes pneumonia, meningitis and blood infections.

Routine Hib vaccination for infants has made epiglottitis rare in children. It's now more common in adults. The condition needs quick care to prevent deadly complications.

Symptoms

Symptoms in children

Children can develop symptoms of epiglottitis within hours. Symptoms can include:

Fever.
Sore throat.
Unusual, high-pitched sound when breathing in, known as stridor.
Difficult and painful swallowing.
Drooling.
Acting anxious and irritable.
Sitting up or leaning forward to ease breathing.

Symptoms in adults

Adults might get symptoms over days rather than hours. Symptoms might include:

Sore throat.
Fever.
A muffled or hoarse voice.
Unusual, high-pitched sound when breathing in, known as stridor.
Difficulty breathing.
Difficulty swallowing.
Drooling.

When to see a doctor

Epiglottitis is a medical emergency. If you or someone you know suddenly has trouble breathing and swallowing, call your local emergency number or go to the nearest hospital emergency department. Try to keep the person quiet and upright, because this position can make it easier to breathe.

Causes

An infection or injury causes epiglottitis.

Infection

In the past, a common cause of swelling and inflammation of the epiglottis and surrounding tissues was infection with Haemophilus influenzae type b (Hib) bacteria. Hib is responsible for other conditions, the most common being meningitis. Hib is now much less common in developed countries where children get Hib vaccines.

Hib spreads when an infected person coughs or sneezes droplets into the air. It's possible to have Hib in the nose and throat without becoming sick. But spreading it to others is still possible.

In adults, other bacteria and viruses also can cause the epiglottis to swell. These include:

Streptococcus pneumoniae (pneumococcus). This bacterium can cause meningitis, pneumonia, ear infection and blood infection.
Streptococcus A, B and C. This group of bacteria can cause diseases from strep throat to blood infection.
Staphylococcus aureus. This bacterium causes skin infections and other diseases including pneumonia and toxic shock syndrome.

Injury

Rarely, physical injury, such as a blow to the throat, can cause epiglottitis. So can burns from drinking very hot liquids and breathing in smoke from a fire.

Symptoms like those of epiglottitis can come from:

Swallowing a chemical that burns the throat.
Swallowing an object.
Smoking drugs, such as crack cocaine.
Smoking electronic cigarettes.

Risk factors

Some factors increase the risk of getting epiglottitis, including:

Having a weakened immune system. An immune system weakened by illness or medicines can be more likely to get bacterial infections that may cause epiglottitis.
Not being fully vaccinated. Skipping vaccinations or not getting them on time can leave a child open to Haemophilus influenzae type b (Hib) and increase the risk of epiglottitis.

Complications

Epiglottitis can cause many complications, including:

Breathing failure. The epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering the windpipe. Swelling of the epiglottis can completely block the airway.

This can lead to breathing or respiratory failure. In this life-threatening condition, the level of oxygen in the blood drops very low.
Spreading infection. Sometimes the bacteria that cause epiglottitis cause infections in other parts of the body. Infections can include pneumonia, meningitis or a bloodstream infection.

Prevention

Hib vaccine

Getting the Haemophilus influenzae type b (Hib) vaccine prevents epiglottitis caused by Hib. In the United States, children usually receive the vaccine in three or four doses:

At 2 months.
At 4 months.
At 6 months if the child is getting the four-dose vaccine.
At 12 to 15 months.

Because children older than 5 and adults are less likely to develop Hib infection, they're not usually given the vaccine. But the Centers for Disease Control and Prevention recommends the vaccine for older children and adults whose immune systems are weak because of:

Sickle cell disease.
HIV/AIDS.
Spleen removal.
Chemotherapy.
Medicine to prevent rejection of organ or bone marrow transplants.

Vaccine side effects

Allergic reaction. An allergic reaction requires swift medical attention. Though rare, an allergic reaction may cause difficulty breathing, wheezing, hives, weakness, a rapid heartbeat or dizziness within minutes or hours after the shot.
Possible mild side effects. These include redness, warmth, swelling or pain at the injection site, and a fever.

Commonsense precautions

The Hib vaccine isn't foolproof. Some vaccinated children have had epiglottitis — and other germs can cause epiglottitis too. That's where using common sense comes in:

Don't share personal items.
Wash hands frequently.
Use an alcohol-based hand sanitizer if soap and water aren't available.

Diagnosis

First, the medical team ensures that the airway is open and that enough oxygen is getting through. The team monitors breathing and blood oxygen levels.

Oxygen levels that drop too low might need breathing aid.

Tests after breathing is stable

Throat exam. Using a flexible fiber-optic-lighted tube, a health care provider looks at the throat through the nose to see what's causing the symptoms. A numbing medicine applied to the nose can make the test more comfortable. This might be done in an operating room in case the airway becomes blocked.
Chest or neck X-ray. They're not needed for a diagnosis, but X-rays might help providers check if you have epiglottitis. With epiglottitis, the X-ray may show what looks like a thumbprint in the neck. This is a sign of an enlarged epiglottis.
Throat culture and blood tests. Once breathing is stable, a team member wipes the epiglottis with a cotton swab and checks the tissue sample for Hib. Blood cultures can find out whether there's an infection of the blood known as bacteremia. Bacteremia often is present with epiglottitis.

Treatment

Helping a person breathe is the first step in treating epiglottitis. Then treatment focuses on the infection.

Helping with breathing

Making sure that you or your child is breathing well might mean:

Wearing an oxygen mask. The mask sends oxygen to the lungs.
Having a breathing tube placed into the windpipe through the nose or mouth, known as intubation. The tube stays in place until the swelling in the throat goes down. This can take many days.
Putting a needle into the windpipe, known as a needle cricothyroidotomy. In rare cases, a health care provider creates an emergency airway. To get air into the lungs quickly, a provider puts a needle into an area of cartilage in the windpipe, also known as the trachea.

Treating infection

Antibiotics given through a vein treat epiglottitis.

Broad-spectrum antibiotic. The infection needs quick treatment. So, a health care provider might prescribe a broad-spectrum drug right away, rather than waiting for results of the blood and tissue cultures.
More-targeted antibiotic. The first medicine may be changed later, depending on what's causing the epiglottitis.

Preparing for an appointment

Epiglottitis is a medical emergency, so you won't have time to prepare for your appointment. The first health care provider you see might be in an emergency room.