Epiglottitis

Page last reviewed: 13/07/2011

Epiglottitis is inflammation and swelling of the epiglottis, which is caused by infection in most cases.

What is the epiglottis?

The epiglottis is a flap of tissue that is located towards the back of the throat and sits beneath the tongue. The main function of the epiglottis is to close over the windpipe (the trachea) when you are eating food. This prevents food from passing down your windpipe and into your lungs.

Due to its close proximity to the windpipe, swelling of the epiglottis can potentially be very serious as it can restrict the supply of oxygen to the lungs (respiratory failure).

Therefore, epiglottitis should be regarded as a medical emergency. Left untreated, the symptoms of respiratory failure can rapidly worsen and may result in death, sometimes within a few hours.

How common is epiglottitis?

In the past, epiglottitis was a widespread infection among children between 2-7 years old. This is because children of this age were particularly vulnerable to infection by the haemophilus influenzae type b (Hib) bacteria, which was a leading cause of epiglottitis.

However, epiglottitis is now very rare since the introduction of the Hib vaccine during the 1990s, which is now part of the routine childhood vaccination schedule.

Cases of epiglottitis still sometimes occur because bacteria other than type b Hib can cause the condition. Also, the Hib vaccine is not always 100% effective (although it has an impressive effectiveness rating of 99.4% in young children).

It is estimated that each year there is one case of epiglottitis in every 200,000 children, and one case in every 100,000 adults.

Adult epiglottitis usually affects men who are between 50-60 years old. The reasons for this are uncertain.

Outlook

If prompt treatment is provided to assist with a person's breathing, the outlook for epiglottitis is very good. Almost everyone will make a full recovery within a week. Deaths from epiglottitis are now very rare.

The most effective way to protect your child against epiglottitis is to make sure that their vaccinations are up to date. 

Page last reviewed: 13/07/2011

The symptoms of epiglottitis usually develop quickly and get rapidly worse. Symptoms include:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • a severe sore throat
  • difficulty and pain when swallowing - most children refuse to eat due to the pain
  • difficulty breathing
  • breathing that sounds abnormal and high-pitched
  • the skin takes on a bluish tinge (cyanosis)
  • voice sounds muffled
  • drooling saliva

When to seek medical advice

Any situation where a person suddenly develops breathing difficulties should always be regarded as a medical emergency. If someone is having problems breathing, dial 112 or 999 and request an ambulance.

Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).

Page last reviewed: 13/07/2011

Haemophilus influenzae type b (Hib) bacteria

The most common cause of epiglottitis is the Haemophilus influenzae type b (Hib) bacteria. Children are particularly vulnerable to a Hib infection because they have an underdeveloped immune system. Hib can cause a number of serious types of infection, including:

  • epiglottitis
  • pneumonia (infection of the lungs)
  • meningitis (infection of the outer membranes of the brain)

Due to the success of the Hib vaccination programme, Hib-related infections are rare, although they can occasionally occur as a result of the few cases of vaccination failures.

The Hib bacteria is spread in a similar way to the cold or influenza (flu) viruses. People who are infected with the Hib bacteria (most of whom will not have any symptoms) can spread the virus when they cough or sneeze by releasing tiny droplets of saliva and mucus that contain the virus.

The infected droplets can also contaminate surfaces and objects. Anyone who places their hand on a contaminated surface or object may develop an infection if they bring their hand near their face or mouth.

Other causes

Less common causes of epiglottitis include:

  • other bacterial infections, such as streptococcus pneumoniae (a common cause of pneumonia)
  • fungal infections - people with a weakened immune system are most at risk from these types of infection
  • the varicella zoster virus - the virus responsible for chickenpox
  • trauma to the throat - such as a blow to the throat, or burning the throat by drinking very hot liquids
  • smoking illegal drugs, such as cannabis or crack cocaine.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Chemotherapy
Chemotherapy is a treatment of an illness or disease with a chemical substance, e.g. in the treatment of cancer.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Vaccination
Vaccination or immunisation is usually given by an injection that makes the body's immune system produce antibodies that will fight off a virus.

Page last reviewed: 13/07/2011

In suspected cases of epiglottitis, the first priority is to ensure that you or your child can breathe properly and that the lungs are getting enough oxygen. See the treatment section for more information about 'securing the airways'. Any tests that need to be done will only be carried out once this has been achieved.

Fibre-optic laryngoscopy

A flexible tube with a camera attached to one end will be used to examine the inside of your throat. This procedure is known as fibre-optic laryngoscopy.

A fibre-optic laryngoscopy is usually only carried out in adults and older children. This is because younger children may find it difficult to understand why the procedure is being done. It could make them very anxious and increase their breathing difficulties.

Other tests

Blood tests are taken to check the number of white blood cells (a low number usually indicates the presence of an infection). They also look for any traces of bacteria or viruses in the blood.

A small sample of tissue (biopsy) may also be taken from the epiglottis and tested to see if any bacteria or viruses are present in the tissue.

If the diagnosis remains inconclusive, imaging studies can be used in order to study the throat and epiglottis. For example, you may have:

  • an X-ray
  • computerised tomography (CT) scan
Anxiety
Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood test
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.

Page last reviewed: 13/07/2011

Epiglottitis is a medical emergency that requires immediate treatment and admission to the nearest hospital.

Securing the airways

The first priority in treating cases of epiglottitis is to ensure that you are able to breathe. This is known as securing the airways.

Your care team will first try to secure your airways using an oxygen mask that delivers highly concentrated oxygen to the lungs. If this does not work, a tube will be placed in your mouth and will slide past your epiglottis and into your windpipe. The tube is connected to an oxygen supply.

If the situation is critical and there is an urgent need to secure the airways, your care team may use a needle to puncture an area of skin in your windpipe. This will allow oxygen to enter your lungs while by-passing the epiglottis.

Once the airways have been secured and your breathing is unrestricted, doctors may seek a more comfortable and convenient way of assisting your breathing. This is usually achieved by threading a tube through your nose and into your windpipe.

Treating the infection

After your airways have been secured, the source of the infection will need to be treated. This is done by giving you injections of broad spectrum antibiotics.

Broad spectrum antibiotics are antibiotics that are designed to treat a wide range of different bacterial infections. Once the type of infection has been identified, a more specific type of antibiotic may be used.

Most people will need to take a 7-10 day course of antibiotics. As your symptoms improve, you may be given antibiotic tablets (oral antibiotics) rather than injections (intravenous antibiotics).

Antibiotic
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Bronchodilators
Bronchodilator medicines are used to widen the airways of the lungs to help with breathing difficulties. For example, salbutamol.
Dehydrated
Dehydration is an excessive loss of fluids and minerals from the body.
Drip
A drip is used to pass fluid or blood into your bloodstream, through a plastic tube and needle that goes into one of your arteries or veins.
Heart
The heart is a muscular organ that pumps blood around the body.
Intravenous
Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Oxygen
Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Tracheostomy
A tracheostomy is a small opening in the windpipe to open up the airway. A tube can be inserted into the hole if the patient needs more help to breath.
Vein
Veins are blood vessels that carry blood from the rest of the body back to the heart.

Page last reviewed: 13/07/2011

The most effective way to prevent your child from getting epiglottitis is to make sure that their vaccinations are up to date.

Children should receive their haemophilus influenzae type b (Hib) as part of the combined childhood vaccination programme. This also protects against diphtheria, polio, tetanus and whooping cough.

Children should receive three doses of the vaccine when they are two, four and six months old. This is followed by an additional 'booster' shot at the age of 13 months.

Contact your GP if you are not sure whether your child's vaccinations are up to date.

Dose
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.

Page last reviewed: 13/07/2011

Epiglottitis can be a fatal condition if your airways become totally blocked by the swelling and emergency treatment is not given quickly. Deaths from epiglottitis are rare, and occur in less than 1 in 100 cases.

In some  cases, an infection can spread from the epiglottis to nearby parts of the body, including the:

  • inner ear (otitis media)
  • brain (meningitis)
  • heart lining (pericarditis)
  • lungs (pneumonia)
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Heart
The heart is a muscular organ that pumps blood around the body.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain, and sometimes a feeling of heat in the affected area.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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