What is epiglottitis and how does it affect breathing. How can you recognize the symptoms of epiglottitis in children and adults. When should you seek immediate medical attention for epiglottitis.

Understanding Epiglottitis: A Potentially Life-Threatening Condition

Epiglottitis is a serious medical condition characterized by inflammation and swelling of the epiglottis, a small flap of tissue at the base of the tongue. This crucial structure plays a vital role in preventing food and liquids from entering the windpipe during swallowing. When the epiglottis becomes infected or inflamed, it can obstruct the airway, leading to severe breathing difficulties and potentially fatal consequences if left untreated.

The severity of epiglottitis cannot be overstated. It is a medical emergency that requires immediate attention and treatment. The condition can progress rapidly, sometimes within hours, making swift diagnosis and intervention crucial for a positive outcome.

Historical Context and Changing Patterns of Epiglottitis

Epiglottitis has a rich historical context, with its first accurate description credited to Andrew Lemierre in 1936. Interestingly, some speculate that George Washington’s death in 1796, initially attributed to quinsy (peritonsillar abscess), may have actually been due to epiglottitis.

In the past, epiglottitis was more prevalent in children due to their smaller epiglottic openings. However, the landscape of this condition has changed significantly since the introduction of the Haemophilus influenzae type b (Hib) vaccine in 1985. This vaccination has led to a dramatic decrease in pediatric cases, shifting the demographic profile of epiglottitis patients.

Current Incidence and Demographic Shifts

Today, epiglottitis is relatively rare, with an estimated incidence of 1 case per 100,000 people annually in the United States. The condition now affects adults more frequently than children, a reversal of historical trends. It’s worth noting that epiglottitis in infants under one year of age remains uncommon.

Causes and Risk Factors of Epiglottitis

Epiglottitis can arise from various causes, with infections being the most common culprit. Understanding these causes is crucial for prevention and early intervention.

Infectious Causes

• Bacterial infections: Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and other streptococcal species
• Viral infections: Various respiratory tract viruses
• Fungal infections: Less common but possible, especially in immunocompromised individuals

Individuals with compromised immune systems are at a higher risk of developing epiglottitis from these infectious agents.

Non-Infectious Causes

While less common, epiglottitis can also result from non-infectious causes:

• Thermal injury: Consuming extremely hot liquids or foods, or inhaling hot substances (e.g., from drug use)
• Physical trauma: Blunt injuries to the throat area
• Allergic reactions: Rare cases linked to specific triggers, such as buffalo fish consumption
• Chemical irritants: Exposure to certain chemicals or substances that irritate the throat

Is epiglottitis always caused by an infection? While infections are the most common cause, epiglottitis can also result from thermal injuries, physical trauma, or allergic reactions. This highlights the importance of considering a range of potential triggers when diagnosing the condition.

Recognizing the Symptoms of Epiglottitis

The symptoms of epiglottitis can vary between children and adults, and understanding these differences is crucial for prompt recognition and treatment.

Symptoms in Children

In children, epiglottitis often develops rapidly, with symptoms appearing within hours. Key signs to watch for include:

• Sudden onset of a severe sore throat
• High fever
• Stridor (a high-pitched whistling sound during breathing)
• Muffled or changed voice
• Drooling
• Anxiety or restlessness
• Sitting leaned forward with an open mouth
• Difficulty speaking or swallowing
• Blue-tinged skin (cyanosis) in severe cases

Notably, children with epiglottitis often do not cough, which can help distinguish it from other respiratory conditions.

Symptoms in Adults

In adults and older children, the onset of epiglottitis is typically more gradual, developing over a few days. Common symptoms include:

• Severe sore throat
• Fever
• Hoarse or muffled voice
• Stridor
• Pain or difficulty when swallowing
• Drooling
• Irritability or restlessness

Can epiglottitis symptoms differ between children and adults? Yes, the onset and presentation of epiglottitis can vary significantly between age groups. Children often experience a rapid onset of symptoms within hours, while adults may develop symptoms more gradually over several days.

Diagnosing Epiglottitis: A Delicate Process

Diagnosing epiglottitis requires a careful and cautious approach due to the potential for rapid airway obstruction. Medical professionals must balance the need for accurate diagnosis with the risk of exacerbating the condition.

Initial Assessment

The diagnostic process typically begins with a thorough evaluation of symptoms and medical history. Healthcare providers will be particularly alert to signs of respiratory distress, such as stridor, difficulty breathing, or a muffled voice.

Physical Examination

A physical examination is conducted with extreme caution. Direct visualization of the throat using a tongue depressor is generally avoided, as it can trigger a laryngospasm and complete airway obstruction. Instead, healthcare providers may use indirect methods to assess the airway.

Imaging Studies

Imaging plays a crucial role in confirming the diagnosis of epiglottitis:

• Lateral neck X-ray: This can reveal a swollen epiglottis, often described as having a “thumb sign” appearance
• CT scan: Provides more detailed images and can help identify any abscesses
• Flexible laryngoscopy: Performed under controlled conditions to directly visualize the epiglottis

Laboratory Tests

Blood tests may be conducted to check for signs of infection and inflammation. In some cases, throat cultures may be taken to identify the specific pathogen causing the infection.

Why is the diagnosis of epiglottitis considered delicate? The diagnostic process for epiglottitis requires extreme caution because any manipulation of the throat area can potentially trigger complete airway obstruction. This risk necessitates a careful balance between obtaining diagnostic information and ensuring patient safety.

Emergency Treatment and Management of Epiglottitis

Epiglottitis is a medical emergency that requires immediate and specialized care. The primary goal of treatment is to secure the airway and address the underlying cause of inflammation.

Airway Management

The most critical aspect of epiglottitis treatment is maintaining a patent airway:

• Intubation: In severe cases, endotracheal intubation may be necessary to ensure adequate oxygenation
• Tracheostomy: If intubation is not possible, an emergency tracheostomy may be performed
• Oxygen therapy: Supplemental oxygen is provided to maintain adequate blood oxygen levels

Medication

Once the airway is secured, medical treatment focuses on addressing the underlying cause:

• Antibiotics: Intravenous antibiotics are administered to combat bacterial infections
• Corticosteroids: These may be used to reduce inflammation and swelling
• Pain management: Analgesics are given to alleviate pain and discomfort

Supportive Care

Patients with epiglottitis require close monitoring in an intensive care unit. Supportive measures may include:

• Intravenous fluids to prevent dehydration
• Nutritional support, often through a feeding tube
• Continuous monitoring of vital signs and respiratory status

How long does it take to recover from epiglottitis? The recovery time from epiglottitis can vary depending on the severity of the condition and the individual’s overall health. With prompt and appropriate treatment, most patients begin to show improvement within 24-48 hours. However, complete recovery may take several days to a week or more, particularly in severe cases.

Complications and Long-Term Outlook of Epiglottitis

While epiglottitis is a serious condition, prompt and appropriate treatment significantly improves the prognosis. However, potential complications can arise, and understanding these is crucial for comprehensive care.

Potential Complications

• Airway obstruction: The most immediate and life-threatening complication
• Epiglottic abscess: Pockets of infection that may form in the epiglottis
• Pneumonia: Secondary lung infections can develop
• Sepsis: In severe cases, the infection can spread to the bloodstream
• Pulmonary edema: Fluid accumulation in the lungs following airway obstruction

Long-Term Outlook

The long-term prognosis for patients with epiglottitis is generally good, provided they receive prompt and appropriate treatment. Most individuals recover fully without lasting effects. However, the experience can be traumatic, and some patients may require psychological support during recovery.

In rare cases, particularly if there was prolonged oxygen deprivation, neurological complications may occur. Regular follow-up appointments are crucial to monitor for any lingering symptoms or complications.

Are there any long-term effects of epiglottitis? While most patients recover fully from epiglottitis without lasting effects, some may experience psychological impacts from the traumatic experience. In rare cases of prolonged oxygen deprivation, neurological complications could occur. Regular follow-up care is essential to monitor for and address any potential long-term effects.

Preventing Epiglottitis: Vaccination and Risk Reduction

Prevention plays a crucial role in reducing the incidence of epiglottitis, particularly in children. Understanding and implementing preventive measures can significantly decrease the risk of developing this potentially life-threatening condition.

Vaccination

The most effective preventive measure against epiglottitis is vaccination, particularly against Haemophilus influenzae type b (Hib):

• Hib vaccine: This vaccine is part of the standard childhood immunization schedule in many countries
• Pneumococcal vaccine: Also recommended for children and certain high-risk adults

The widespread use of these vaccines has dramatically reduced the incidence of epiglottitis, especially in children.

Other Preventive Measures

While vaccination is the primary preventive strategy, other measures can help reduce the risk of epiglottitis:

• Practicing good hygiene: Regular handwashing can help prevent the spread of infectious agents
• Avoiding hot foods and liquids: To prevent thermal epiglottitis
• Protecting the throat area: Using appropriate protective gear in activities with a risk of throat injury
• Managing underlying conditions: Properly controlling conditions that affect immune function

How effective is vaccination in preventing epiglottitis? Vaccination, particularly against Haemophilus influenzae type b (Hib), has been highly effective in reducing the incidence of epiglottitis. Since the introduction of the Hib vaccine, there has been a dramatic decrease in cases of epiglottitis, especially in children. This underscores the critical role of vaccination in public health efforts to prevent this serious condition.

In conclusion, epiglottitis remains a serious medical condition that requires immediate attention and treatment. While its incidence has decreased significantly due to widespread vaccination, awareness of its symptoms, causes, and preventive measures remains crucial. Prompt recognition and appropriate management are key to ensuring positive outcomes for individuals affected by this potentially life-threatening condition. As medical knowledge and treatments continue to advance, the outlook for patients with epiglottitis continues to improve, highlighting the importance of ongoing research and public health efforts in this area.

Epiglottitis (Epiglottis) Infection or Inflammation

Written by WebMD Editorial Contributors

• What is Epiglottitis?
• Epiglottitis Causes
• Epiglottitis Symptoms
• Epiglottitis Diagnosis
• Epiglottitis Treatment
• Epiglottitis Complications
• Epiglottitis Prevention
• Epiglottitis Outlook
• More

Epiglottitis is a medical emergency. If not treated quickly, it can be fatal.  

The epiglottis is a flap of tissue at the base of the tongue that keeps food from going into the trachea, or windpipe, during swallowing. When it gets infected or inflamed, it can obstruct (block) or close off your windpipe, which makes you unable to breathe.

Respiratory infection, things in the environment, or trauma may cause inflammation and infection of other areas around the throat. The infection and inflammation may spread to the epiglottis and other areas. 

Epiglottitis usually begins as an inflammation and swelling between the base of the tongue and the epiglottis. With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to suffocation and death. Even a little narrowing of the windpipe can dramatically increase the resistance of an airway, making breathing much more difficult.

Autopsies of people with epiglottitis have shown distortion of the epiglottis and its associated structures, including the formation of abscesses (pockets of infection). For unknown reasons, adults with epiglottic involvement are more likely than children to develop epiglottic abscesses.

Epiglottitis was first described in the 18th century but was first accurately defined by Andrew Lemierre in 1936. In fact, although George Washington’s death in 1796 was attributed by some to quinsy (today we call it peritonsillar abscess), which is a pocket of pus behind the tonsils, it could have actually been due to epiglottitis.

In the past, epiglottitis was more common in children than in adults. This difference was believed to be because of the smaller diameter of children’s epiglottic opening when compared with those of adults. Epiglottitis in children under the age of 1 year is unusual.

In the past, Haemophilus influenzae type b (or Hib) was the most common organism related to epiglottitis. Since 1985, with the widespread vaccination against Hib, far fewer children have gotten the disease. 

A conservative estimate of the incidence of epiglottitis is 1 case per 100,000 people in the U.S. each year.

Most epiglottitis is caused by bacterial, fungal or viral infection, especially among adults.

• Common infectious causes are Haemophilus influenzae, Streptococcus pneumoniae and other strep species, and respiratory tract viruses. People who have immune system problems are in greater danger of infection.

• Other types of epiglottitis are caused by heat damage. Thermal epiglottitis occurs from drinking hot liquids; eating very hot solid foods; or using illicit drugs (i.e., inhaling the tips of marijuana cigarettes or metal pieces from crack cocaine pipes). In these cases, the epiglottitis from thermal injury is similar to the illness caused by infection.

Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result in swelling, or eating buffalo fish, which may cause an allergic-like reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.

When epiglottitis strikes, it usually occurs quickly, from just a few hours to a few days. The most common symptoms include sore throat, muffling or changes in the voice, difficulty speaking, swallowing or breathing, fever, and fast heart rate.

Symptoms in children often happen within hours. They include:

• Upper respiratory infections 

• Sudden, very sore throat 

• Fever  

• Stridor, a high-pitched whistling sound when your child breathes in

• Muffled voice 

• Drooling

• No coughing

• Anxiety or restlessness  

• Leaning forward while seated

• Keeping their mouth open

• Not being able to talk

• Trouble breathing

• Blue skin, a condition called cyanosis  

Adults and older children often have symptoms that come on over a few days, such as:

• Very sore throat

• Fever 

• Hoarse or muffled voice 

• Stridor 

• Pain or difficulty in swallowing 

• Drooling

• Irritability or restlessness 

When to seek medical care

Call 911 or go to the nearest emergency room if you have a sore throat accompanied by any of the following signs and symptoms:

• Muffled voice

• Swallowing problems

• Difficulty speaking

• Fast heartbeat

• Irritability

• Bluish skin

• Respiratory distress with drooling, shortness of breath, rapid shallow breathing, very ill-looking appearance, sitting upright with a tendency to lean forward, and stridor (high-pitched sound when breathing in)

Epiglottitis is a medical emergency. Anyone who might have epiglottitis should be taken to the hospital immediately. Try to keep the person as calm and comfortable as possible. Make no attempt at home to inspect the throat of a person suspected of having epiglottitis. This can cause the windpipe and surrounding tissues to close and an irregular heart beat, which can lead to respiratory and/or cardiac arrest (stopping of breathing and/or heart) and death.

• The doctor may perform X-rays or simply look at the epiglottis and the windpipe by laryngoscopy.

  • The doctor may find that the pharynx is inflamed with a beefy, cherry-red, stiff and swollen epiglottis.

  • Manipulating the epiglottis may result in sudden fatal airway obstruction, and irregular slow heart rates have occurred with attempts at intubation (putting a tube down the throat and placing the person on a machine that helps with breathing). That’s why the doctor will likely use an operating room or intensive care unit to examine the throat.

• Other laboratory tests may include:

  • Blood tests to look for infection or inflammation

  • Tests to measure oxygen in the blood

  • Blood cultures (blood samples that may grow bacteria), which can indicate the cause of the epiglottitis

  • Other tests to find antibodies to specific bacteria or viruses (immunologic tests)

  • In intubated patients, epiglottal culture

These laboratory tests may not be useful in diagnosing epiglottitis until the person is stable. Also, the anxiety from having blood drawn or cultures taken from the throat may cause the unstable epiglottis to close off, completely blocking the airway and creating an emergency with only a few minutes to correct.

Even with all of our modern technology, epiglottitis is not easy to diagnose. It is often mistaken for strep throat or croup. Epiglottitis differs from croup by its worsening progress, lack of a barking cough, and a cherry-red, swollen epiglottis (unlike a red, unswollen epiglottis in croup). One way doctors can tell epiglottitis from croup is by taking X-rays of the neck, which can show the swollen epiglottis.

Other misdiagnoses of epiglottitis include diphtheria, peritonsillar abscess, and infectious mononucleosis.

Non-infectious causes have been mistaken as angioedema (swelling of the tissues in the airway), laryngeal inflammation or spasm, laryngeal trauma, cancerous growths, allergic reactions, thyroid gland infection, epiglottic hematoma (trapped blood pocket), hemangioma (abnormal collection of blood vessels), or inhalational injury.

Immediate hospitalization is required whenever the diagnosis of epiglottitis is suspected. The person is in danger of sudden and unpredictable closing of the airway. So doctors must establish a secure way for the person to breathe. Antibiotics may be given.

• Treatment of epiglottitis may start with making the person as comfortable as possible. For instance, an ill child may be placed in a dimly lit room with the parent holding the child. Then, the child may get humidified oxygen while being closely watched. If there are no signs of respiratory distress, IV fluids may be helpful. It is important to prevent anxiety, because it may lead to an acute airway obstruction, especially in children.

• People with possible signs of airway obstruction require laryngoscopy in the operating room or intensive care unit with proper staff and airway intervention equipment. In very severe cases, the doctor may need to perform a cricothyrotomy (cutting the neck to insert a breathing tube directly into the windpipe).

• IV antibiotics may effectively control inflammation and get rid of the infection from the body. Antibiotics are usually prescribed to treat the most common types of bacteria. Blood cultures are usually taken to show whether an organism is growing in the blood that could be causing the epiglottitis. In many cases, blood cultures may not show if this is the problem. If a patient is intubated, cultures taken directly from the epiglottis may work better.

Corticosteroids and epinephrine have been used in the past. However, many experts now doubt that these drugs are helpful in most cases of epiglottitis.

Treatment follow-up 

Take all antibiotics until the full course is completed. Keep all follow-up appointments with the doctor — and with the surgeon if a breathing tube had to be placed through the neck. The surgeon will remove the tube and make sure the site is healing well. Most people feel much better before leaving the hospital, so taking the antibiotics and returning to the hospital if there are any problems are the most important parts of follow-up.

Possible complications of epiglottitis include: 

Epiglottitis can often be prevented with proper vaccination against H influenza type b (Hib). Adults usually do not need the vaccine unless they have immune problems like sickle cell anemia, splenectomy (removal of the spleen), cancers, or other diseases affecting the immune system.

If other people live with a Hib-infected person, preventive drugs such as rifampin (Rifadin) should be given to anyone else in the house who is:

• Under the age of 4 and has not received all the Hib vaccinations

• Under 12 months and has not finished the first series of Hib vaccine

• Under age 18 with a weakened immune system

This is done to make sure that both the person with the illness and the rest of the household do not have the bacteria. This prevents a “carrier state” from forming in which a person has the bacteria in the body but is not actively sick. Carriers can still spread the infection to other family members.

A person with epiglottitis can recover very well with a good prognosis if the condition is caught early and treated in time. In fact, a good majority of people with epiglottitis do well and recover without problems. But if the person was not brought to the hospital early and was not appropriately diagnosed and treated, the prognosis may range from long-range illness to death.

• Before 1973, about 32% of adults with epiglottitis died from the disease. With current vaccination programs and earlier recognition and treatment, the death rate from epiglottitis is estimated to be less than 1%. The death rate from epiglottitis in adults is higher than that of children because the condition can be misdiagnosed.

Epiglottitis can also occur with other infections in adults, such as pneumonia. If it is caught early and treated, a person can expect to fully recover. Most of the deaths come from failure to diagnose it quickly and obstruction of the airway. As with any serious infection, bacteria may enter the blood, a condition called bacteremia, which may result in infections in other systems and sepsis (severe infection with shock, often with respiratory failure).

Top Picks

Epiglottitis (Epiglottis) Infection or Inflammation

Written by WebMD Editorial Contributors

• What is Epiglottitis?
• Epiglottitis Causes
• Epiglottitis Symptoms
• Epiglottitis Diagnosis
• Epiglottitis Treatment
• Epiglottitis Complications
• Epiglottitis Prevention
• Epiglottitis Outlook
• More

Epiglottitis is a medical emergency. If not treated quickly, it can be fatal.  

The epiglottis is a flap of tissue at the base of the tongue that keeps food from going into the trachea, or windpipe, during swallowing. When it gets infected or inflamed, it can obstruct (block) or close off your windpipe, which makes you unable to breathe.

Respiratory infection, things in the environment, or trauma may cause inflammation and infection of other areas around the throat. The infection and inflammation may spread to the epiglottis and other areas. 

Epiglottitis usually begins as an inflammation and swelling between the base of the tongue and the epiglottis. With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to suffocation and death. Even a little narrowing of the windpipe can dramatically increase the resistance of an airway, making breathing much more difficult.

Autopsies of people with epiglottitis have shown distortion of the epiglottis and its associated structures, including the formation of abscesses (pockets of infection). For unknown reasons, adults with epiglottic involvement are more likely than children to develop epiglottic abscesses.

Epiglottitis was first described in the 18th century but was first accurately defined by Andrew Lemierre in 1936. In fact, although George Washington’s death in 1796 was attributed by some to quinsy (today we call it peritonsillar abscess), which is a pocket of pus behind the tonsils, it could have actually been due to epiglottitis.

In the past, epiglottitis was more common in children than in adults. This difference was believed to be because of the smaller diameter of children’s epiglottic opening when compared with those of adults. Epiglottitis in children under the age of 1 year is unusual.

In the past, Haemophilus influenzae type b (or Hib) was the most common organism related to epiglottitis. Since 1985, with the widespread vaccination against Hib, far fewer children have gotten the disease. 

A conservative estimate of the incidence of epiglottitis is 1 case per 100,000 people in the U. S. each year.

Most epiglottitis is caused by bacterial, fungal or viral infection, especially among adults.

• Common infectious causes are Haemophilus influenzae, Streptococcus pneumoniae and other strep species, and respiratory tract viruses. People who have immune system problems are in greater danger of infection.

• Other types of epiglottitis are caused by heat damage. Thermal epiglottitis occurs from drinking hot liquids; eating very hot solid foods; or using illicit drugs (i.e., inhaling the tips of marijuana cigarettes or metal pieces from crack cocaine pipes). In these cases, the epiglottitis from thermal injury is similar to the illness caused by infection.

Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result in swelling, or eating buffalo fish, which may cause an allergic-like reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.

When epiglottitis strikes, it usually occurs quickly, from just a few hours to a few days. The most common symptoms include sore throat, muffling or changes in the voice, difficulty speaking, swallowing or breathing, fever, and fast heart rate.

Symptoms in children often happen within hours. They include:

• Upper respiratory infections 

• Sudden, very sore throat 

• Fever  

• Stridor, a high-pitched whistling sound when your child breathes in

• Muffled voice 

• Drooling

• No coughing

• Anxiety or restlessness  

• Leaning forward while seated

• Keeping their mouth open

• Not being able to talk

• Trouble breathing

• Blue skin, a condition called cyanosis  

Adults and older children often have symptoms that come on over a few days, such as:

• Very sore throat

• Fever 

• Hoarse or muffled voice 

• Stridor 

• Pain or difficulty in swallowing 

• Drooling

• Irritability or restlessness 

When to seek medical care

Call 911 or go to the nearest emergency room if you have a sore throat accompanied by any of the following signs and symptoms:

• Muffled voice

• Swallowing problems

• Difficulty speaking

• Fast heartbeat

• Irritability

• Bluish skin

• Respiratory distress with drooling, shortness of breath, rapid shallow breathing, very ill-looking appearance, sitting upright with a tendency to lean forward, and stridor (high-pitched sound when breathing in)

Epiglottitis is a medical emergency. Anyone who might have epiglottitis should be taken to the hospital immediately. Try to keep the person as calm and comfortable as possible. Make no attempt at home to inspect the throat of a person suspected of having epiglottitis. This can cause the windpipe and surrounding tissues to close and an irregular heart beat, which can lead to respiratory and/or cardiac arrest (stopping of breathing and/or heart) and death.

• The doctor may perform X-rays or simply look at the epiglottis and the windpipe by laryngoscopy.

  • The doctor may find that the pharynx is inflamed with a beefy, cherry-red, stiff and swollen epiglottis.

  • Manipulating the epiglottis may result in sudden fatal airway obstruction, and irregular slow heart rates have occurred with attempts at intubation (putting a tube down the throat and placing the person on a machine that helps with breathing). That’s why the doctor will likely use an operating room or intensive care unit to examine the throat.

• Other laboratory tests may include:

  • Blood tests to look for infection or inflammation

  • Tests to measure oxygen in the blood

  • Blood cultures (blood samples that may grow bacteria), which can indicate the cause of the epiglottitis

  • Other tests to find antibodies to specific bacteria or viruses (immunologic tests)

  • In intubated patients, epiglottal culture

These laboratory tests may not be useful in diagnosing epiglottitis until the person is stable. Also, the anxiety from having blood drawn or cultures taken from the throat may cause the unstable epiglottis to close off, completely blocking the airway and creating an emergency with only a few minutes to correct.

Even with all of our modern technology, epiglottitis is not easy to diagnose. It is often mistaken for strep throat or croup. Epiglottitis differs from croup by its worsening progress, lack of a barking cough, and a cherry-red, swollen epiglottis (unlike a red, unswollen epiglottis in croup). One way doctors can tell epiglottitis from croup is by taking X-rays of the neck, which can show the swollen epiglottis.

Other misdiagnoses of epiglottitis include diphtheria, peritonsillar abscess, and infectious mononucleosis.

Non-infectious causes have been mistaken as angioedema (swelling of the tissues in the airway), laryngeal inflammation or spasm, laryngeal trauma, cancerous growths, allergic reactions, thyroid gland infection, epiglottic hematoma (trapped blood pocket), hemangioma (abnormal collection of blood vessels), or inhalational injury.

Immediate hospitalization is required whenever the diagnosis of epiglottitis is suspected. The person is in danger of sudden and unpredictable closing of the airway. So doctors must establish a secure way for the person to breathe. Antibiotics may be given.

• Treatment of epiglottitis may start with making the person as comfortable as possible. For instance, an ill child may be placed in a dimly lit room with the parent holding the child. Then, the child may get humidified oxygen while being closely watched. If there are no signs of respiratory distress, IV fluids may be helpful. It is important to prevent anxiety, because it may lead to an acute airway obstruction, especially in children.

• People with possible signs of airway obstruction require laryngoscopy in the operating room or intensive care unit with proper staff and airway intervention equipment. In very severe cases, the doctor may need to perform a cricothyrotomy (cutting the neck to insert a breathing tube directly into the windpipe).

• IV antibiotics may effectively control inflammation and get rid of the infection from the body. Antibiotics are usually prescribed to treat the most common types of bacteria. Blood cultures are usually taken to show whether an organism is growing in the blood that could be causing the epiglottitis. In many cases, blood cultures may not show if this is the problem. If a patient is intubated, cultures taken directly from the epiglottis may work better.

Corticosteroids and epinephrine have been used in the past. However, many experts now doubt that these drugs are helpful in most cases of epiglottitis.

Treatment follow-up 

Take all antibiotics until the full course is completed. Keep all follow-up appointments with the doctor — and with the surgeon if a breathing tube had to be placed through the neck. The surgeon will remove the tube and make sure the site is healing well. Most people feel much better before leaving the hospital, so taking the antibiotics and returning to the hospital if there are any problems are the most important parts of follow-up.

Possible complications of epiglottitis include: 

Epiglottitis can often be prevented with proper vaccination against H influenza type b (Hib). Adults usually do not need the vaccine unless they have immune problems like sickle cell anemia, splenectomy (removal of the spleen), cancers, or other diseases affecting the immune system.

If other people live with a Hib-infected person, preventive drugs such as rifampin (Rifadin) should be given to anyone else in the house who is:

• Under the age of 4 and has not received all the Hib vaccinations

• Under 12 months and has not finished the first series of Hib vaccine

• Under age 18 with a weakened immune system

This is done to make sure that both the person with the illness and the rest of the household do not have the bacteria. This prevents a “carrier state” from forming in which a person has the bacteria in the body but is not actively sick. Carriers can still spread the infection to other family members.

A person with epiglottitis can recover very well with a good prognosis if the condition is caught early and treated in time. In fact, a good majority of people with epiglottitis do well and recover without problems. But if the person was not brought to the hospital early and was not appropriately diagnosed and treated, the prognosis may range from long-range illness to death.

• Before 1973, about 32% of adults with epiglottitis died from the disease. With current vaccination programs and earlier recognition and treatment, the death rate from epiglottitis is estimated to be less than 1%. The death rate from epiglottitis in adults is higher than that of children because the condition can be misdiagnosed.

Epiglottitis can also occur with other infections in adults, such as pneumonia. If it is caught early and treated, a person can expect to fully recover. Most of the deaths come from failure to diagnose it quickly and obstruction of the airway. As with any serious infection, bacteria may enter the blood, a condition called bacteremia, which may result in infections in other systems and sepsis (severe infection with shock, often with respiratory failure).

Top Picks

Epiglottitis: Causes of epiglottitis, Prevalence of the disease, Diagnosis and treatment of epiglottitis

Epiglottitis is commonly referred to as inflammation of the epiglottis and surrounding tissues. It can lead to severe airway obstruction. Acute epiglottitis occurs in children aged 2-4 years. However, older children and adults can also get sick.

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Pediatric otolaryngologist (ENT ) of the highest category, candidate of medical sciences, has been treating diseases in children related to the ears, throat and nose for 28 years. Specializes in otolaryngology, phoniatrics, otosurgery, plastic and reconstructive surgery

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