Epiglottitis - Causes, Treatment & When to See a Doctor

What is Epiglottitis?

Epiglottitis is a rare but serious condition characterized by inflammation and swelling of the

epiglottis—the flap located at the base of the tongue that acts as a flap to prevent food and fluids from entering the airway. This swelling can partially or completely block the airway, leading to difficulty breathing, which is a life-threatening emergency. While once a common cause of mortality in children, the incidence of epiglottitis has dramatically decreased due to widespread vaccination against Haemophilus influenzae type B (Hib). However, it remains a critical condition requiring immediate medical attention.

Symptoms often develop rapidly and can affect people of all ages, though it is more common in children under 5 and adults over 50. Early recognition of symptoms is crucial to prevent complications such as respiratory failure.

Common Causes

Epiglottitis can be caused by various infections or injuries. Below are the most common causes:

• Haemophilus influenzae type B (Hib): Responsible for most cases in children before the introduction of the Hib vaccine. Still a risk in unvaccinated individuals or adults in regions with low vaccination coverage (CDC, 2023).
• Other bacteria: Streptococcus, Staphylococcus, and Moraxella species can cause epiglottitis, especially in immunocompromised individuals (Mayo Clinic, 2022).
• Viruses: Influenza A/B, respiratory syncytial virus (RSV), and mumps have been linked to viral forms of epiglottitis (NIH, 2021).
• Fungal infections: Rare but possible in individuals with weakened immune systems (WHO, 2020).
• Trauma or injury: Direct injury to the epiglottis from surgery or accidents (Cleveland Clinic, 2023).
• Foreign bodies: Objects accidentally inhaled or ingested that irritate the epiglottis (CDC, 2023).
• Allergic reactions: Rare cases of swelling due to severe allergic responses (NIH, 2021).
• HIV/AIDS: Weakened immunity increases susceptibility to infections, including those causing epiglottitis (CDC, 2023).
• Gastroesophageal reflux disease (GERD): Chronic acid reflux can sometimes contribute to inflammation (Mayo Clinic, 2022).
• Post-intubation complications: Mechanical irritation from medical devices (Cleveland Clinic, 2023).
• Tuberculosis: Rarely, TB can lead to epiglottic inflammation (NIH, 2021).

Associated Symptoms

Epiglottitis often presents with distinctive symptoms that can worsen quickly. Be aware of these

• High fever: Typically above 101°F (38.3°C), often sudden in onset.
• Difficulty swallowing: Pain or inability to swallow due to swelling.
• Drooling: A hallmark sign in children, as they avoid swallowing due to pain (paradoxical swallowing reflex).
• Muffled or hoarse voice: Resulting from vocal cord swelling or obstruction.
• Stridor: A high-pitched sound during breathing caused by airway narrowing.
• Respiratory distress: Labored, rapid breathing or grunting.
• Rapid breathing: Tachycardia and shortness of breath are common.
• Sweating: Excessive sweating, especially in infants and children.
• Severe pain: Intense throat pain that may radiate to the neck or jaw.
• Cyanosis: Bluish discoloration of the skin due to oxygen deprivation (if severe).

When to See a Doctor

Epiglottitis is a medical emergency. Seek immediate care if you or someone else experiences

• Trouble breathing: Stridor, gasping, or inability to catch a breath.
• Difficulty swallowing: Even minor discomfort warrants urgent evaluation.
• High fever: Especially in children or adults with no known cause.
• Drooling or inability to swallow: A critical sign in children.
• Hoarseness: Sudden change in voice quality.
• Rapid onset of symptoms: Rapid progression over hours indicates a possible emergency.

Do not delay care—epiglottitis can lead to respiratory failure within minutes if untreated. Contact emergency services or visit the nearest emergency department immediately.

Diagnosis

Due to its life-threatening nature, diagnosis of epiglottitis relies on rapid assessment and clinical evaluation. Here’s how doctors diagnose it:

• Physical examination: A healthcare provider will check for signs of swelling, breathing difficulty, and other symptoms. Avoid pressing on the tongue or epiglottis, as this can worsen obstruction.
• Imaging: A lateral neck X-ray or CT scan may be used to visualize swelling and rule out other causes.
• Rapid tests: Blood or throat swabs can identify bacteria (e.g., Hib, strep) or viruses (e.g., influenza).
• Endoscopy: In rare cases, a flexible scope may be used to visualize the airway, though this is risky if swelling is severe.

It is critical to diagnose epiglottitis quickly to begin treatment promptly. If symptoms align with this condition, seek emergency care for proper evaluation.

Treatment Options

Treatment for epiglottitis focuses on reducing airway swelling and addressing the underlying cause. It requires hospitalization and immediate medical intervention. Key treatments include:

• Intravenous (IV) antibiotics: For bacterial causes like Hib or strep. Common choices include ceftriaxone or ciprofloxacin (CDC, 2023).
• Corticosteroids: Administered to reduce inflammation and swelling of the airway (Mayo Clinic, 2022).
• Oxygen therapy: High-flow oxygen or intubation may be necessary to maintain oxygen levels.
• Fluid management: IV fluids to prevent dehydration, especially if swallowing is difficult.
• Avoiding oral intake: No food, drinks, or medications by mouth until the airway is stable.

Home treatments are not recommended for epiglottitis due to the high risk of complications. Strict follow-up with healthcare providers is essential to monitor recovery.

Prevention Tips

While epiglottitis is rare in vaccinated populations, preventive measures can reduce risk:

• Hib vaccination: Ensure children receive the recommended Hib vaccine schedule (CDC, 2023). Adults with risk factors should consult their doctor.
• Good hygiene: Frequent handwashing and avoiding close contact with sick individuals to prevent viral infections.
• Avoid smoking: Secondhand smoke increases respiratory inflammation risk.
• Stay updated on vaccines: Influenza and pneumococcal vaccines may also lower infection risk.
• Monitor for symptoms: If you or a child develop a high fever or throat pain, seek medical attention immediately.

Emergency Warning Signs

Recognize these red flags and act immediately:

• Inability to breathe: Critical sign of airway obstruction.
• Bluish lips or skin: Indicates severe oxygen deprivation.
• Stridor at rest: High-pitched noise even when breathing calmly.
• Unresponsiveness: If the patient becomes unresponsive, perform CPR and call emergency services.
• Difficulty speaking: Hoarseness or inability to form words.
• High fever with drooling: A fatal combination requiring instant care.

If any of these occur, do not delay treatment—call emergency services or take the individual to the nearest hospital immediately. Early intervention can save lives.

Reputable Sources

Information in this article is based on guidelines from:

• Mayo Clinic (2022, 2023): Diagnosing and managing epiglottitis.
• CDC (2023): Hib vaccine impact and epiglottitis prevention.
• National Institutes of Health (NIH): Causes and treatment of epiglottitis.
• World Health Organization (WHO): Rare fungal and tuberculosis-related cases.
• Cleveland Clinic (2023): Emergency care protocols for airway obstruction.