Epiglottitis

Overview

Epiglottitis is an acute inflammatory disorder of the epiglottis and nearby upper-airway structures. Swelling can reduce the diameter of the airway rapidly, so clinicians treat the possibility of obstruction before pursuing a detailed throat examination or nonessential testing. ^{[1] [2]}

Bacterial infection is a common cause. Haemophilus influenzae type b was historically dominant in children; vaccination has shifted the epidemiology, and adults may develop epiglottitis from other bacterial pathogens. Thermal or traumatic injury can produce a similar swollen supraglottic airway without infection. ^{[1] [2]}

Children can deteriorate quickly, but adults also develop severe disease. A patient may have an intense sore throat and difficulty swallowing even when the front of the mouth and tonsils do not look dramatically abnormal, because the swollen tissue is deeper in the throat. ^{[1] [2] [3]}

Symptoms and warning signs

Typical features include severe sore throat, painful or difficult swallowing, fever, muffled or hoarse voice, drooling and breathing difficulty. Stridor, sitting upright and leaning forward, reluctance to lie down, or rapidly increasing work of breathing indicate significant upper-airway narrowing. ^{[1] [2]}

Do not press the tongue down or try to inspect the throat of a person with suspected epiglottitis at home. Agitation and manipulation can worsen obstruction. Call emergency services for stridor, drooling with breathing difficulty, blue color, inability to swallow saliva or rapidly worsening respiratory distress. ^{[1] [2]}

Diagnosis

Diagnosis begins with recognizing the clinical pattern and protecting the airway. If a patient appears unstable, airway management takes priority over imaging, swabs or routine throat inspection. Flexible laryngoscopy may confirm supraglottic swelling when performed by an experienced team in an environment prepared for sudden deterioration. ^{[1] [2]}

Neck radiography or CT can support diagnosis in selected stable patients, but imaging must not delay airway intervention. Blood cultures and cultures from the epiglottic region may identify a pathogen after the airway is secure. Oxygen saturation, blood gas testing and inflammatory markers help assess severity but are not substitutes for direct airway assessment. ^{[1] [2] [3]}

Croup, bacterial tracheitis, peritonsillar or retropharyngeal abscess, anaphylaxis, foreign-body aspiration and severe tonsillitis can all cause upper-airway symptoms. Age, cough quality, drooling, voice change, neck findings and laryngoscopic appearance help distinguish them. ^{[2] [3]}

Causes, risk factors and clinical context

Lack of Hib vaccination increases pediatric risk where Hib circulates. Adults may have no obvious predisposing factor, although smoking, immune compromise and certain chronic diseases can increase susceptibility to severe respiratory infection. Direct upper-airway injury from heat or caustic exposure is a noninfectious cause. ^{[1] [2]}

Without treatment, swelling can progress over hours and critically narrow airflow. With timely airway support and antibiotics, many patients improve over several days, but close monitoring is required because the airway can worsen before inflammation recedes. ^{[1] [2] [3]}

Complications and why the diagnosis matters

Complete airway obstruction is the major immediate complication. Sepsis, pneumonia and spread of infection can occur depending on the pathogen. Intubation itself can be technically difficult because normal landmarks are distorted by swelling. ^{[1] [2]}

Outcome is generally good when epiglottitis is recognized early and the airway is secured before severe hypoxia occurs. Prognosis worsens when there is delayed emergency care, cardiac arrest from obstruction or overwhelming sepsis. ^{[1] [2] [3]}

Treatment and management

Hospital treatment prioritizes oxygenation and airway safety. Patients with significant obstruction may require endotracheal intubation by an experienced airway team; a surgical airway must be available if intubation fails. Empiric intravenous antibiotics are started for likely bacterial pathogens and then refined when culture information is available. ^{[1] [2]}

Intravenous fluids, fever and pain control, and intensive monitoring are commonly needed until swallowing and breathing improve. Corticosteroids are sometimes used to reduce edema, although the decision varies by severity and local practice. Oral intake is resumed only when swallowing is safe. ^{[1] [2] [3]}

A person with suspected epiglottitis should not be sent home with oral antibiotics without an airway assessment. Likewise, forcing a child to lie down, examine the throat or undergo nonessential procedures can precipitate deterioration in a critically narrowed airway. ^{[1] [2]}

Follow-up, recovery and prevention

After recovery, follow-up focuses on completion of antimicrobial therapy when indicated, assessment for complications and confirmation that immunization is up to date. Recurrent epiglottitis is unusual and should prompt evaluation for structural or immune risk factors. ^{[1] [2]}

Routine Hib vaccination is the most important specific preventive measure for Hib-related disease. Good respiratory hygiene and timely treatment of invasive bacterial infection reduce exposure risk, while smoking cessation supports respiratory health more broadly. ^{[1] [2] [3]}

Special situations and care pathway

In adults, symptoms may evolve more slowly than in children and the airway may remain stable long enough for controlled nasolaryngoscopy. In children, clinicians often avoid distressing examination until anesthesia and ENT support are ready because small airway diameter makes swelling especially consequential. ^{[1] [2] [3]}

The care pathway is emergency assessment, minimal agitation, airway-risk stratification, early specialist involvement, airway protection when needed, IV antibiotics and monitored recovery. Diagnostic imaging is secondary to that sequence. ^{[1] [2]}

When to seek urgent medical care

Call emergency services for stridor, drooling with inability to swallow, severe breathing difficulty, blue lips or skin, marked drowsiness or a rapidly worsening sore throat with airway symptoms. ^{[1] [2]}

Sources

1. MedlinePlus — Epiglottitis
2. CDC — Clinical Overview of Haemophilus influenzae Disease
3. NHS — Epiglottitis

This article is based on trusted medical sources and is awaiting clinician review. It is not a substitute for personalized medical advice.