About Epiglottitis

Epiglottitis is a life-threatening condition that occurs when the epiglottis — a small cartilage “lid” that covers your windpipe — swells, blocking the flow of air into your lungs.

A number of factors can cause the epiglottis to swell — burns from hot liquids, direct injury to your throat, and various infections. The most common cause of epiglottitis is infection with Haemophilus influenzae type b (Hib), the same bacterium that causes pneumonia and meningitis.

Routine Hib vaccination for infants has made epiglottitis uncommon, but it remains a concern. If you suspect that you or someone in your family has epiglottitis, seek emergency help immediately. Prompt treatment can prevent life-threatening complications of epiglottitis.

Symptoms

Epiglottitis caused by Hib infection usually begins with a fever and severe sore throat. Symptoms of epiglottitis may develop within a matter of hours, including:

  • Fever
  • Severe sore throat
  • Difficult and painful swallowing
  • Drooling due to severe pain when swallowing
  • A muffled or hoarse voice
  • Harsh, raspy breathing
  • Difficulty breathing
  • Blue skin or lips

Causes

Your voice box (larynx) is a framework of cartilage, muscle and mucous membrane that forms the entrance to your windpipe (trachea), the tube that connects your mouth and throat to your lungs. The epiglottis is a small, movable “lid” just above the larynx that prevents food and drink from entering your windpipe.

It does this by dropping down when you swallow, effectively sealing off the larynx. That’s why you can’t swallow and breathe at the same time. When you’re not eating or drinking, the epiglottis is slightly lifted so that air can flow freely into your lungs. But if the epiglottis becomes swollen — either from infection or from injury — the airway narrows and may become completely blocked.

Infection
The most common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection with Haemophilus influenzae type b (Hib) bacteria. Hib isn’t the germ that causes the flu, but it’s responsible for other serious conditions — including respiratory tract infections and meningitis.

Hib spreads through infected droplets coughed or sneezed into the air. It’s possible to harbor Hib in your nose and throat without becoming sick — though you still have the potential to spread the bacteria to others.

Other bacteria and viruses also can cause inflammation of the epiglottis, including:

  • Streptococcus pneumoniae (pneumococcus), another bacterium that causes meningitis, pneumonia, ear infections and blood infection (sepsis)
  • Streptococcus A, B and C, a group of bacteria that cause diseases ranging from strep throat to blood infections
  • Candida albicans, the fungus responsible for vaginal yeast infections, diaper rash and oral thrush
  • Varicella zoster, the virus responsible for chickenpox and shingles

Injury
Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can scald burns to your face or burns from drinking very hot liquids.

You also may develop signs and symptoms similar to those of epiglottitis if you:

  • Swallow a chemical that burns your throat
  • Swallow a foreign object
  • Smoke drugs such as crack cocaine and heroin

Children ages 2 to 6 are most susceptible to epiglottitis caused by Hib, but since routine childhood Hib immunizations began in the mid-1980s, the number of children with epiglottitis has dropped dramatically. Today the condition affects about one of every 100,000 adults a year and even fewer children.

It’s difficult to predict who might develop epiglottitis, but certain factors increase the risk.

  • Sex. Epiglottitis affects more males than females.
  • Crowded conditions. Hib bacteria spread rapidly when people are in close contact, such as in child care centers, and even in households where one person has been infected. If someone in your family has been infected with Hib, all family members need to be evaluated by a physician and receive preventive treatment, if necessary.
  • Weak immune system. If your immune system has been weakened by illness or medication, you’re more susceptible to the bacterial infections that may cause epiglottitis.

Diagnosis

If the medical team suspects that you have epiglottitis, the first priority is to ensure your airways are open and you’re receiving enough oxygen.

Once your condition is stable, the doctor may examine your throat using a flexible fiber-optic tube. A local anesthetic can help relieve any discomfort. Sometimes you may have a chest or neck X-ray as well. Because of the danger of sudden breathing problems, children may have X-rays taken at their bedside rather than in the radiology department — but only after the airway is protected.

You’re also likely to have a blood test and throat culture. For the culture, your epiglottis is wiped with a cotton swab and the tissue sample is checked for Hib. Blood cultures are usually taken because sepsis — a severe infection — often accompanies epiglottitis.

Epiglottitis can lead to respiratory failure — a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high.

Sometimes the bacteria that cause epiglottitis cause infections elsewhere in the body, such as pneumonia, meningitis or a blood infection (sepsis).

Rarely, pulmonary edema, another life-threatening condition, can develop. It occurs when the tiny air sacs in the lungs fill with fluid, preventing them from absorbing oxygen.

Treatment

The first priority in treating epiglottitis is ensuring that you’re receiving enough air. You may wear a mask that delivers oxygen to your lungs, but it’s more likely that you’ll have a breathing tube placed into your windpipe through your nose or mouth. The tube must remain in place until the swelling in your throat has decreased — sometimes for several days.

In extreme cases or if more conservative measures fail, the doctor may need to create an emergency airway by inserting a needle directly into an area of cartilage in your trachea. This procedure, called a tracheotomy, allows air into your lungs while bypassing the larynx. The needle is removed as soon as the airway is open.

If your epiglottitis is related to an infection, you’ll receive intravenous antibiotics once you’re breathing freely. Until your doctor knows the results of your blood and tissue cultures, you’re likely to be treated with a broad-spectrum drug. You may receive a different antibiotic later, depending on what’s causing your epiglottitis.

Prevention

Immunization with the Hib vaccine is an effective way to prevent epiglottitis in children younger than age 5. In the United States, children usually receive the vaccine in four doses:

  • At ages 2 months
  • At 4 months
  • At 6 months
  • At 12 to 15 months

The Hib vaccine is generally not given to children older than age 5 or to adults because they’re less likely to develop Hib infection. But the Centers for Disease Control and Prevention recommends the vaccine for older children and adults whose immune systems have been weakened by:

  • Sickle cell disease
  • HIV/AIDS
  • Spleen removal
  • Chemotherapy
  • Medications to prevent rejection of organ or bone marrow transplants

Vaccine side effects
The most common side effects of the Hib vaccine include redness, warmth or swelling at the injection site, and a fever. Rarely, a serious allergic reaction may cause difficulty breathing, wheezing, hives, weakness, a rapid heartbeat or dizziness within minutes or a few hours after the shot. If you have an allergic reaction to the vaccine, seek medical help immediately.

Common-sense precautions
Of course, the Hib vaccine doesn’t offer guarantees. Immunized children have been known to develop epiglottitis – and other germs can cause epiglottitis, too. That’s where common-sense precautions come in:

  • Don’t share personal items.
  • Wash your hands frequently.
  • Use an alcohol-based hand sanitizer if soap and water aren’t available.