Epiglottitis is a condition that leads to swelling and inflammation of the epiglottis, which is a flap of cartilage situated in the throat behind a person’s tongue. The job of the epiglottis is to prevent liquids and food items from going down an individual’s trachea or windpipe as they swallow.
Epiglottitis is a life-threatening inflammation and swelling of the epiglottis that can rapidly obstruct the airway. It most often affects children aged 2–6 years but can occur at any age. Immediate action is critical to secure breathing and prevent complete airway blockage.
Signs and Symptoms
- Severe sore throat, often with sudden onset
- High fever, drooling, and difficulty swallowing (dysphagia)
- Hoarse or muffled voice (dysphonia)
- Stridor (a high-pitched sound on inhalation) and labored breathing
- Characteristic “tripod” posture: sitting upright, leaning forward, chin thrust out to aid airflow.
Causes of Epiglottitis
Epiglottitis is mainly caused by the Haemophilus influenza type b (Hib) bacteria, which is the same bacteria that cause meningitis and pneumonia. Some of the other causes of epiglottitis include:
- Bacterial infections that don’t result from the Hib bacteria
- Chemical burns
- Fungal infections
- Smoking
- Side effects of chemotherapy or some other disease
- Throat injury caused by an extremely hot liquid or a physical blow
- Viral infections from the same virus that causes chickenpox
Signs and Symptoms of Epiglottitis
Symptoms of epiglottitis develop quickly in a previously healthy child or after a minor upper respiratory tract infection. They include:
- Sore throat and high fever (up to 105F) which appear suddenly
- Painful swallowing and drooling
- Irritability, agitation and fear
- A muffled voice that becomes scratchy or rasping as the condition worsens. The child may be completely unable to speak.
- Labored and rapid breathing, often noisy
- Skin pallor or blueness
- Characteristic posture: sitting up, leaning forward, mouth open, tongue protruding and neck extended forward— position that facilitates breathing
- Rapid and shallow breathing as obstruction increases
- Rapid heartbeat
Four Ds of Epiglottitis
The four Ds of epiglottitis refer to the most common symptoms related to the condition, and they are:
- Dysphagia: Dysphagia is when a person faces swallowing issues.
- Dysphonia: Dysphonia refers to having an abnormal or hoarse voice.
- Drooling: The involuntary flow of saliva from a person’s mouth.
- Distress: Facing difficulties with breathing or not getting enough oxygen.
First Aid Steps
- Call Emergency Services Immediately Do not delay—suspected epiglottitis requires on-site EMS and rapid transport to hospital.
- Keep the Patient Calm and Upright Encourage the child or adult to sit comfortably—avoid lying flat or forcing them to lie down.
- Do Not Inspect the Throat or Use a Tongue Depressor Any attempt to visualize the epiglottis can trigger spasms, increased swelling, or vomiting, worsening the obstruction.
- Administer Supplemental Oxygen if Available Use a loose-fitting face mask to provide gentle oxygen flow without agitating the patient.
- Monitor Vital Signs Track respiratory rate, effort, and skin color. Watch for signs of deteriorating airway or onset of shock.
Advanced Airway Management (Performed by Professionals)
Once EMS or hospital staff arrive, they will prioritize airway control:
- Oxygen Therapy or Oxygen Mask to support breathing
- Endotracheal Intubation (placing a breathing tube through the mouth or nose) to secure the airway until swelling subsides
- Emergency Cricothyroidotomy (needle or surgical) in rare cases where intubation fails
Antibiotic therapy (broad-spectrum initially, then targeted based on cultures) and corticosteroids to reduce inflammation follow stabilization of the airway.
Do’s and Don’ts
| Do | Don’t |
|---|---|
| Call for emergency medical help without delay | Attempt to examine the throat |
| Keep the patient seated and calm | Force the patient to lie flat |
| Provide gentle oxygen if trained and equipped | Give oral fluids or food |
| Watch for changing breathing patterns and color | Insert any instruments or fingers |
Epiglottitis in Children
Children who don’t get the Hib vaccine face a higher risk of developing epiglottitis. The symptoms of epiglottitis in children are as follows:
Muffled voice
- Sore throat
- Difficulty swallowing
- Drooling
- Skin that appears blue
- Fever
Once a child displays symptoms of epiglottitis, they need to be taken to a hospital immediately, where their breathing will first be brought under control, after which a doctor will check their airway. An X-ray or laryngoscopy could be recommended by some healthcare providers.
The treatment for epiglottitis in children can include:
- Administering IV fluids till the child can swallow properly again
- Steroid medication to bring down the swelling in the airway
- IV therapy that includes antibiotics if the condition is caused by a bacterial infection
Prevention
While preventing epiglottitis isn’t always easy, there are certain measures one can take to reduce the risks associated with it, and those measures include:
- Maintaining good hygiene: Wash your hands frequently and whenever necessary, and avoid placing your fingers in your mouth, nose, and eyes.
- Staying updated with your vaccinations: Make sure your child receives all the important vaccinations to protect them from infections.
- Being careful of throat injuries: Smoking or consuming liquids that are too hot can amplify the risk of epiglottitis.
- Protecting yourself from infections: Keep yourself protected from infections, especially when you’re around those who are sneezing or coughing.
REFERENCES
- Guerra AM, Waseem M. Epiglottitis. https://www.ncbi.nlm.nih.gov/books/NBK430960/). 2024 Oct 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
- Khorrami A, Khorrami MA, Gheriani H. Vaping-induced acute epiglottitis: a case report. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481551/. Int J Emerg Med. 2023;16(1):56.
- Lu A, Hsu CM, Tsai YT, Tsai MS, Chang GH. Chemical Burn-Induced Corrosive Epiglottitis in an Elderly Patient with Major Depression. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10056630/). Life (Basel). 2023 Mar;13(3):804
- Epiglottitis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis#.
- Sutton AE, Guerra AM, Waseem M. Epiglottitis. [Updated 2024 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430960/
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