Epiglottitis is a bacterial infection of the epiglottis.
The epiglottis is a small flap of stiff tissue that closes the entrance to the voice box (larynx) and trachea during swallowing. Sometimes, the epiglottis becomes infected with bacteria, usually Haemophilus influenzae type B. Haemophilus influenzae--related epiglottitis was most common among children, but routine vaccination against Haemophilus has almost eliminated this infection in children. Now more cases of epiglottitis occur in adults. However, children may get epiglottitis caused by other bacteria, and unvaccinated children can be infected by Haemophilus.
The swelling caused by this infection may block the airway and lead to difficulty breathing and death. Because children have a smaller airway than adults, epiglottitis is more dangerous in children (see Bacterial Infections in Infants and Children: Epiglottitis) but can also be fatal in adults.
Symptoms are severe throat pain, difficulty swallowing, fever, drooling, and a muffled voice. Because the infection is in the epiglottis, the back of the throat often does not appear infected. As swelling of the epiglottis starts to narrow the airway, the person first begins to make a squeaking noise when breathing in (stridor) and then has progressively worse trouble breathing. The condition progresses rapidly.
A doctor suspects the diagnosis based on the person's symptoms. If an adult is not having stridor or any trouble breathing, the doctor may look down the throat with a mirror or take x-rays, which often show the swollen epiglottis. Sometimes the doctor looks down the throat with a thin, flexible viewing tube inserted through the nose (nasopharyngeal laryngoscopy). Children are more likely to have sudden, complete blockage of their airway, particularly when their throat is examined. To minimize this danger, doctors usually examine the throat and epiglottis only in the operating room and do not send children for x-rays.
Epiglottitis caused by Haemophilus influenzae type B can be effectively prevented with the Haemophilus influenzae type B (Hib) vaccine.
A person without difficulty breathing is given antibiotics and is hospitalized and closely observed in an intensive care unit. If the person has difficulty breathing, doctors insert a plastic breathing tube through the mouth or nose into the trachea (endotracheal intubation). The tube keeps the airway from swelling shut. Sometimes the airway is so swollen that the doctor cannot insert a tube this way and must cut open the front of the neck and insert the tube directly into the trachea (tracheotomy or cricothyroidotomy).
Last full review/revision July 2008 by Clarence T. Sasaki, MD