Merck Manual

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Alan G. Cheng

, MD, Stanford University

Reviewed/Revised Feb 2024
Topic Resources

Epiglottitis is a bacterial infection of the epiglottis and surrounding tissues.

  • Epiglottitis may block the windpipe (trachea) and be fatal.

  • The main symptoms are severe sore throat, drooling, and noisy, difficult breathing.

  • Doctors make the diagnosis by looking at the epiglottis with a thin, flexible viewing tube, typically in an operating room.

  • The Haemophilus influenzae type B (Hib) vaccine can prevent epiglottitis caused by some of these bacterial infections.

  • Antibiotics are given to eliminate the infection, and a breathing tube is inserted to keep the airway from swelling shut.

The Throat, Vocal Cords, and Epiglottis

The epiglottis is a small flap of stiff tissue that closes the entrance to the voice box (larynx) and trachea during swallowing.

Ear, Nose, and Throat

Ear, Nose, and Throat

Causes of Epiglottitis

Sometimes the epiglottis becomes infected with bacteria.

Epiglottitis caused by Haemophilus influenzae Haemophilus influenzae Infections Haemophilus influenzae are gram-negative bacteria that can cause infection in the respiratory tract, which can spread to other organs. Infection is spread through sneezing, coughing,... read more type Bused to be 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 adults and unvaccinated children can still be infected by Haemophilus influenzae type B.

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 much more dangerous in children but can also be fatal in adults.

Children with epiglottitis often have bacteria in the bloodstream (bacteremia Bacteremia Bacteremia is the presence of bacteria in the bloodstream. Bacteremia may result from ordinary activities (such as vigorous toothbrushing), dental or medical procedures, or from infections ... read more ), which sometimes spreads the infection to the lungs, the joints, the tissues covering the brain (meninges), the sac around the heart, or the tissues beneath the skin.

Symptoms of Epiglottitis

In children with epiglottitis, symptoms develop suddenly, and fatal narrowing of the larynx can occur within a few hours of the start of symptoms. Symptoms include

  • Severe throat pain

  • Difficulty swallowing

  • Pain when swallowing

  • Fever

  • Drooling

  • 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 child first begins to make a squeaking or gasping sound when breathing in (stridor Stridor Stridor is a gasping sound during inhalation resulting from a partial blockage of the throat (pharynx), voice box (larynx), or windpipe (trachea). Stridor is usually loud enough to be heard... read more ) and then has progressively worse trouble breathing. The condition progresses rapidly.

In adults with epiglottitis, symptoms are similar to those of children, including sore throat, fever, difficulty swallowing, and drooling, but symptoms usually take more than 24 hours to develop. Because the adult airway is larger, blockage of the airway is less common and less sudden. However, the airway can still become blocked, and adults may die if diagnosis and treatment are delayed.

Often, in children and adults, there is no visible inflammation in the throat. Thus, when people have severe throat pain but a normal-appearing throat, doctors may suspect they have epiglottitis.

Diagnosis of Epiglottitis

  • Direct examination (typically in operating room)

  • Sometimes x-rays

Epiglottitis is suspected in people with a severe sore throat and stridor or other symptoms of epiglottitis if their throat appears normal. If doctors suspect epiglottitis, the person is hospitalized.

Doctors diagnose epiglottitis by looking at the epiglottis with a thin, flexible viewing tube (laryngoscope), typically in an operating room.

X-rays may be taken when symptoms are mild and epiglottitis seems less likely.

Samples of blood or tissues around the epiglottis may be cultured (sent to a laboratory to try to grow bacteria) to identify the bacteria causing the infection.

Prevention and Treatment of Epiglottitis

  • A breathing tube

  • Antibiotics

In treating a person with epiglottitis, doctors make sure the person's airway is open. Children are taken to the operating room, and a plastic breathing tube is inserted through the mouth into the trachea (orotracheal intubation). The tube keeps the airway from swelling shut. Doctors also place a breathing tube in adults who are having difficulty breathing, particularly those whose airway is severely blocked. However, adults who do not have difficulty breathing may not need a breathing tube and can be closely observed in an intensive care unit. The breathing tube is usually needed for 60 hours or less.

If a breathing tube cannot be inserted, doctors can do a temporary tracheotomy, creating a hole in the trachea so that the person can breathe.

All adults and children with epiglottitis are given antibiotics (such as ceftriaxone). Antibiotics may be changed based on results of the culture.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Ceftrisol Plus, Rocephin
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