Epiglottitis: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr Shashi Kiran Somala , ENT

Epiglottitis is a medical emergency characterized by inflammation and swelling of the epiglottis, the flap of tissue that covers the windpipe during swallowing. The condition is most commonly caused by bacterial infections, particularly Haemophilus influenzae type b (Hib), although other bacteria, viruses, fungi, trauma, or burns can also be responsible. Symptoms typically develop rapidly and include severe sore throat, difficulty swallowing, drooling, muffled voice, fever, and breathing difficulty. Without prompt treatment, the swollen epiglottis can block the airway, making early diagnosis and immediate medical care essential to prevent life-threatening complications.

What are the Symptoms of Epiglottitis?

The symptoms of epiglottitis can develop rapidly, often within hours. Common signs include:

What are the Causes of Epiglottitis?

Various factors, including bacterial, viral, and fungal infections can cause epiglottitis. The most common bacterial cause is Haemophilus influenzae type b (Hib), although other bacteria such as Streptococcus pneumoniae and Staphylococcus aureus can also be responsible. Non-infectious causes include trauma to the throat, burns, or chemical exposure.

In adults, epiglottitis is more commonly associated with a broader range of bacterial infections and underlying health conditions that compromise immunity, such as diabetes or chronic illnesses. Fungal infections, though rare, can affect individuals with severely weakened immune systems, including those undergoing chemotherapy or living with HIV/AIDS.

Additionally, non-infectious factors such as direct injury to the throat, inhalation of hot steam or smoke, ingestion of sharp objects, or exposure to harmful chemicals can damage the epiglottis and trigger inflammation.

When to See a Doctor for Epiglottitis?

Anyone with severe sore throat, difficulty swallowing, drooling, or breathing problems should seek immediate evaluation by an Emergency Physician. An Ear, Nose, and Throat (ENT) Specialist is often involved in ongoing management.

You should seek immediate medical care if you experience:

Call emergency medical services immediately if you:

These symptoms indicate a potentially blocked airway and require emergency medical treatment without delay.

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How Is Epiglottitis Diagnosed?

Diagnosing epiglottitis requires a high index of suspicion, especially in patients presenting with acute onset of symptoms. The following diagnostic methods are commonly used:

Clinical Examination

A thorough clinical examination is vital. Observing the patient's breathing pattern, voice quality, and signs of respiratory distress can provide initial clues. However, direct visualization of the throat should be avoided as it may trigger a complete airway obstruction.

Imaging Studies for Epiglottitis

Imaging studies, such as lateral neck X-rays, are instrumental in confirming the diagnosis. The "thumb sign" on an X-ray is a classic indicator of epiglottitis, where the swollen epiglottis appears like a thumbprint.

Laryngoscopy

A flexible laryngoscopy performed by an experienced clinician can provide a direct view of the inflamed epiglottis. This procedure should be done in a controlled environment like an operating room or an intensive care unit, where emergency airway management equipment is readily available.

What are the Treatment Options for Epiglottitis?

Once the airway is secured, the focus shifts to treating the underlying cause and managing symptoms.

Medications Used in Treating Epiglottitis

Antibiotics

Broad-spectrum antibiotics are typically administered until the specific causative agent is identified. Common choices include:

Corticosteroids

Corticosteroids like dexamethasone may be used to reduce inflammation and edema, although their use remains controversial and should be tailored to individual cases.

Analgesics and Antipyretics

Medications like acetaminophen or ibuprofen can be used to manage pain and fever.

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What are the Complications Associated with Epiglottitis?

If not promptly treated, epiglottitis can lead to severe complications, including:

What is the Long-term Management and Prevention of Epiglottitis?

Long-term management includes completing treatment, regular follow-up, and prevention through vaccination, good hygiene, and avoiding risk factors.

Vaccination

The introduction of the Hib vaccine has significantly reduced the incidence of epiglottitis, particularly in children. Ensuring up-to-date vaccinations is crucial for prevention.

Follow-up Care

Patients who have recovered from epiglottitis should be monitored for any potential recurrence or long-term complications. Follow-up appointments with an ENT specialist may be necessary.

Lifestyle Modifications

For individuals with non-infectious causes of epiglottitis, such as trauma or chemical exposure, lifestyle modifications and avoidance of known triggers are essential preventive measures.

What is the Recovery Process of Epiglottitis?

Recovery from epiglottitis depends on early treatment and proper medical care. Most patients improve with timely intervention and monitoring.