What to Know About Epiglottitis
This article will explain more about epiglottitis, including the signs, symptoms, and treatment of epiglottitis. It will also discuss the infections that can cause epiglottitis and ways to prevent it.
The epiglottis is an important structure because it covers the top of the trachea and prevents food from getting into the lungs when you eat. It is part of the larynx, which sits atop the windpipe. The larynx has three parts:
- Supraglottis: This includes the epiglottis.
- Glottis: This includes the vocal cords.
- Subglottis: This is the structure below the glottis.
As a 2021 review article in StatPearls explains, epiglottitis involves inflammation of the epiglottis. A more accurate term is supraglottitis, as inflammation usually involves the entire supraglottis. The structures around it can also swell.
This can lead to swelling in the entire upper airway and an airway blockage, which makes it very difficult to breathe. Epiglottitis can even make it so you are unable to breathe. Severe epiglottitis can be fatal.
The signature symptoms of epiglottitis may be referred to as “the 4 Ds.” These include:
Epiglottitis symptoms in adults
In adults, symptoms tend to come on slowly over 3–4 days. The most common symptoms of epiglottitis in adults, listed from most to least common, include:
- sore throat
- pain or difficulty with swallowing
- difficulty breathing
- hoarse or muffled voice
- stridor, which is when breathing in sounds very high-pitched from a narrowed airway
Epiglottitis symptoms in children
In children, symptoms tend to arise swiftly, within 12–24 hours. Typical symptoms include:
Children with epiglottitis will often try to breathe easier by leaning forward. They may hyperextend the neck in an attempt to keep their airway open.
When to see a doctor
Epiglottitis can quickly swell the airway to the point that it can be difficult to establish an emergency airway.
For this reason, seek immediate medical attention — call 911 — for anyone experiencing shortness of breath or stridor.
Epiglottitis can be life threatening, but, according to the National Health Society (NHS), death from epiglottitis is still very rare.
In children, Haemophilus influenzae type b (Hib) infection is the most common cause of epiglottitis. Scientists developed an effective vaccine against Hib bacteria in 1987. Hib vaccination is part of the routine childhood vaccination panel in the United States. The vaccine has significantly decreased the incidence of epiglottitis in children in the U.S.
Other causes of epiglottitis include:
- Streptococcus (strep) infection
- Staphylococcus aureus (staph) infection
- damage from burns or trauma
- swallowing a foreign object
In addition, the bacterium Pseudomonas aeruginosa and the yeast Candida have caused epiglottitis in people with a suppressed immune system.
Viruses are not a common direct cause of epiglottitis, but viral respiratory infections, such as the flu, can lead to secondary bacterial infections that can cause epiglottitis.
Of note, a 2021 article documented a case of epiglottitis in a patient with COVID-19, which is caused by SARS-CoV-2 infection.
Factors that affect epiglottitis
The physical structure of the upper airway is different in children than in adults. The epiglottis is more flexible in babies than adults and is in a different position. These features make epiglottitis symptoms more likely in children vs. adults. Although an adult epiglottis is stiffer than a child’s, progression of epiglottitis can also be dangerous for an adult.
Other factors that increase the chance of epiglottitis include:
- being immunocompromised
- not being immunized against Hib with the vaccine
Potential complications of epiglottitis include those related to the infectious cause or to the effect on breathing. These include:
- spread of infection, such as to the lymph nodes
- empyema, an infection in the lining of the lungs
- abscess of the epiglottis
- respiratory failure
- septic shock
- low oxygen levels
If a medical professional suspects epiglottitis, they will check the person’s breathing and secure the airway before establishing the diagnosis. This is particularly important in children, as moving them around, such as to collect a throat swab, has the potential to cause complete closure of the airway.
Doctors diagnose epiglottitis by a physical examination and an X-ray that can show the swollen tissue.
A doctor will also distinguish epiglottitis from another similar upper airway condition called croup, which can cause difficulty breathing. Croup is easily distinguished from epiglottitis because croup has a very distinctive “barking” cough associated with it.
The doctor may obtain a sample from the patient’s mouth or airway to find the cause of epiglottitis. This test is known as a culture because the laboratory determines which bacteria can be grown, or cultured, from the sample.
The cultures can take several days to grow. The doctor may start treating the infection before the culture results come back. If necessary, they can adjust treatment afterward.
Treatment for epiglottitis in an emergency medical setting may involve securing an alternate airway and reducing swelling. Not all people with epiglottitis will need another airway, but the medical team has on hand the supplies for establishing an emergency airway.
Treatment will generally follow this order:
- establish an alternate airway if necessary, which may involve either of these two procedures:
- administer oxygen through the alternate airway
- administer corticosteroids to reduce swelling
- administer other medications as necessary, including oxygen, breathing treatments, and antibiotics
With medical treatment, most people with epiglottitis will get better in 2–3 days. However, antibiotic therapy continues for at least 1 week.
What you can do to help a child with epiglottitis
Children who are having trouble breathing due to epiglottitis (or any condition) can become very anxious. This can worsen symptoms. If you are caring for a child, try to stay calm. Comfort and reassure them that help is on the way or that the treatment they are already receiving will make them feel better soon.
Keep your child sitting up too, since lying down can make symptoms worse.
The best way to prevent epiglottitis from Hib disease is to follow the recommended vaccine schedule for children, according to the Centers for Disease Control and Prevention (CDC). The Hib schedule is a shot at:
- 2 months old
- 4 months old
- 6 months old, although this may not be necessary if the child receives a 2-dose series vaccine
- booster dose at 12–15 months
The CDC does not recommend Hib vaccination for adults in general, except if they are receiving a bone marrow transplant, chemotherapy, or radiation therapy, or have a medical condition, such as HIV infection, that suppresses the immune system.
Because infections are the most common cause of epiglottitis, the following infection-prevention strategies may help reduce the chance of epiglottitis:
- Wash your hands regularly.
- Avoid people who are sick.
- Get regular recommended vaccinations for your age group, including pneumonia, flu, and COVID-19 vaccines.
- Do not smoke or spend time in environments where smoking is present.
Here are other questions people often ask about epiglottitis.
How quickly does epiglottitis progress?
Epiglottitis can progress in 12–24 hours in children and over a few days in adults.
Can COVID-19 cause epiglottitis?
People with COVID-19 can develop epiglottitis, as published case reports show. The direct cause — COVID-19 or a secondary bacterial infection — is not always known. However, clinicians administered antibiotics (along with standard COVID-19 treatments) and all patients survived, consistent with the possibility that a secondary bacterial infection was the cause of epiglottitis in these patients.
Epiglottitis is a life threatening condition in which the epiglottis, the flap covering the trachea — part of the upper airway — becomes swollen.
The swelling can block off the airway in a matter of hours, particularly in a child. Always seek emergency medical attention for difficulty breathing, especially if the person is displaying the signature “4 Ds” of epiglottitis: distress, difficulty swallowing, drooling, and difficulty speaking.