Table of Contents
Definition
Epiglottitis is an acute inflammation and swelling of the epiglottis (a flap of cartilage at the base of the tongue that prevents food from entering the airway).
It is a medical emergency because swelling can rapidly block the airway. (Mayo Clinic)
Anatomy and Function of Epiglottis
- Located above the larynx.
- Acts like a “lid” over the trachea during swallowing.
- Prevents aspiration of food and liquids into the lungs.
Causes
Infectious Causes
- Haemophilus influenzae type b (Hib) – classic cause in children
- Streptococcus pneumoniae
- Streptococcal species
- Staphylococcus aureus
- Viral or fungal infections (less common)
Non-infectious Causes
- Hot liquid burns
- Trauma to throat
- Chemical injury
- Smoking/vaping or inhaling drugs (Mayo Clinic)
Risk Factors
- Lack of Hib vaccination
- Weak immune system
- Diabetes
- Smoking
- Young children (historically), though now more common in adults
Clinical Features
Symptoms
- Severe sore throat
- Fever
- Difficulty swallowing (dysphagia)
- Painful swallowing (odynophagia)
- Drooling
- Muffled or “hot potato” voice
- Difficulty breathing
- Stridor (high-pitched breathing sound)
Signs
- Patient sits leaning forward (tripod position)
- Anxiety/restlessness
- Cyanosis in severe cases
Classic Presentation
“3 D’s” of Epiglottitis
- Drooling
- Dysphagia
- Distress (respiratory)
Diagnosis
Clinical Diagnosis
- Do not aggressively examine throat in severe cases because it may worsen airway obstruction.
Investigations
- Laryngoscopy
- Neck X-ray → Thumb sign
- Blood culture/throat swab
- Pulse oximetry (Mayo Clinic)
Management
Emergency Management
- Secure airway first
- Oxygen
- Endotracheal intubation if needed
- Rarely tracheostomy
- Medications
- IV antibiotics
- Corticosteroids
- IV fluids
- ICU monitoring
Complications
- Sudden airway obstruction
- Respiratory failure
- Sepsis
- Death if untreated (Mayo Clinic)
Prevention
- Hib vaccination is the best preventive measure.
- Good hygiene and infection control.
Difference Between Epiglottitis and Croup
| Feature | Epiglottitis | Croup |
|---|---|---|
| Onset | Sudden | Gradual |
| Fever | High | Mild |
| Cough | Usually absent | Barking cough |
| Drooling | Present | Rare |
| Voice | Muffled | Hoarse |
| Age | Older children/adults | Young children |
| Emergency | Severe emergency | Usually mild |
Key Points to Remember
- Life-threatening airway emergency.
- Drooling + stridor + muffled voice = suspect epiglottitis.
- Do not force throat examination.
- Airway management is priority.
- Hib vaccine greatly reduced cases.
Epiglottitis