Epiglottitis is inflammation of the epiglottis—the flap at the base
of the tongue that keeps food from going into the trachea
(windpipe). Symptoms are usually rapid in onset and include trouble
swallowing which can result in drooling, changes to the voice, fever,
and an increased breathing rate. As the epiglottis is in the
upper airway, swelling can interfere with breathing. People may
lean forward in an effort to open the airway. As the condition
worsens stridor and bluish skin may occur.
Epiglottitis was historically mostly caused by infection by H.
influenzae type b. With vaccination it is now more often caused by
other bacteria. Other possible causes include burns and trauma to
the area. The most accurate way to make the diagnosis is to look
directly at the epiglottis. X-rays of the neck from the side may
show a "thumbprint sign" but the lack of this sign does not mean the
condition is absent.
An effective vaccine, the Hib vaccine, has been available since the
1980s. The antibiotic rifampicin may also be used to prevent the
disease among those who have been exposed to the disease and are at
high risk. The most important part of treatment involves securing
the airway, which is often done by endotracheal intubation.
Intravenous antibiotics such as ceftriaxone and possibly vancomycin or
clindamycin is then given.
Corticosteroids are also typically
used. With appropriate treatment, the risk of death among children
with the condition is about one percent and among adults is seven
With the use of the Hib vaccine, the number of cases of epiglottitis
has decreased by more than 95%. While historically young children
were mostly affected, it is now more common among older children and
adults. In the United States it affects about 1.3 per 100,000
children a year. In adults between 1 and 4 per 100,000 are affected
a year. It occurs more commonly in the developing world. In
children the risk of death is about 6%; however, if they are intubated
early is less than 1%.
1 Signs and symptoms
5.1 Airway management
8 Notable cases
10 External links
Signs and symptoms
Epiglottitis is associated with fever, difficulty in swallowing,
drooling, hoarseness of voice, and typically stridor.
Stridor is a
sign of upper airways obstruction and is a surgical emergency. The
child often appears acutely ill, anxious, and has very quiet shallow
breathing with the head held forward, insisting on sitting up in bed.
The early symptoms are insidious but rapidly progressive, and swelling
of the throat may lead to cyanosis and asphyxiation.
Since the introduction of the
Hemophilus influenzae (Hib) vaccination
in many Western countries, childhood incidence has decreased while
adult incidence has remained the same; the disease is thus becoming
relatively more common in adults than children.
Epiglottitis is typically due to a bacterial infection of the
epiglottis. While it historically was most often caused by
Haemophilus influenzae type B with immunization this is no longer the
Bacteria that are now typically involved are Streptococcus
Streptococcus pyogenes, or Staphylococcus aureus.
Other possible causes include burns and trauma to the area.
Epiglottitis has been linked to crack cocaine usage. Graft versus
host disease and lymphoproliferative disorder can also be a cause.
Diagnosis is confirmed by direct inspection using laryngoscopy,
although this may provoke airway spasm. If epiglottitis is suspected,
attempts to visualise the epiglottis using a tongue depressor are
strongly discouraged for this reason; therefore, diagnosis is made on
basis of direct fibreoptic laryngoscopy carried out in controlled
environment like an operating room. Imaging is rarely useful, and
treatment should not be delayed for this test to be carried out.
The epiglottis and arytenoids are cherry-red and swollen. The most
likely differential diagnostic candidates are croup, peritonsillar
abscess, and retropharyngeal abscess.
C-spine X-ray, the thumbprint sign describes a swollen,
enlarged epiglottis; usually with dilated hypopharynx and normal
On CT imaging, the "halloween sign" describe a normal thickness
epiglottis. It can safely exclude the acute epiglottitis. Furthermore,
CT imaging can help to diagnose other conditions such as peritonsillar
abscess or retropharyngeal abscess which had similar clinical
CT imaging showing the "halloween sign"
Left column: Normal epiglottis. Right column: Epiglottitis.
Swollen epiglottis in laryngoscopy
Hib vaccine is very effective at preventing the disease.
In household contacts of any unvaccinated child infected with H.
influenzae, rifampicin is used as prophylaxis.
Epiglottitis may require urgent tracheal intubation to protect the
airway, though this is not always the case.
Tracheal intubation can be
difficult due to distorted anatomy and profuse secretions. Spontaneous
respiration is ideally maintained until tracheal intubation is
successful. A surgical airway opening (cricothyrotomy) may be required
if intubation is not possible.
In addition, people should be given antibiotics, such as second- or
third-generation cephalosporins, either alone or in combination with
penicillin or ampicillin for streptococcal coverage. If allergy to
penicillins is present,
Co-trimoxazole or clindamycin is an
While historically young children were mostly affected, it is now more
common among older children and adults. Before immunization
children of two to four were most commonly affected. With
immunization about 1.3 per 100,000 children are affected a year.
Some patients may develop pneumonia, lymphadenopathy, or septic
Sarah Silverman spent a week in the ICU at
Cedars Sinai Hospital
Cedars Sinai Hospital with
George Washington is thought to have died of epiglottitis. The
treatments given to George Washington, such as severe bloodletting, an
enema, vinegar, sage, molasses, butter, blistering his throat with
Spanish fly, requiring him to swallow mercurous chloride and antimony
potassium tartrate, and applying wheat poultices to various parts of
the body, are no longer used.
^ a b c d e f g h i j k l m n o p q r s t u v Richards, AM (February
2016). "Pediatric Respiratory Emergencies". Emergency medicine clinics
of North America. 34 (1): 77–96. doi:10.1016/j.emc.2015.08.006.
^ a b c d e Zoorob, R; Sidani, MA; Fremont, RD; Kihlberg, C (1
November 2012). "
Antibiotic use in acute upper respiratory tract
infections". American Family Physician. 86 (9): 817–22.
^ a b c d Westerhuis, B; Bietz, MG; Lindemann, J (August 2013). "Acute
epiglottitis in adults: an under-recognized and life-threatening
condition". South Dakota medicine : the journal of the South
Dakota State Medical Association. 66 (8): 309–11, 313.
^ a b c d e f g Schlossberg, David (2015). Clinical infectious disease
(Second ed.). p. 202. ISBN 9781107038912. Archived from the
original on 2016-08-16.
^ a b Blacklow, Neil R. (2004). Infectious diseases (3rd ed.).
Philadelphia: Lippincott Williams & Wilkins. p. 461.
ISBN 9780781733717. Archived from the original on
^ a b Textbook of Adult Emergency Medicine (4 ed.). Elsevier Health
Sciences. 2014. p. 291. ISBN 9780702054389. Archived from
the original on 15 August 2016. Retrieved 15 July 2016.
^ a b Hamborsky, j (2015). "Haemophilus influenzae type b". Centers
for Disease Control and Prevention. Epidemiology and Prevention of
Vaccine-Preventable Diseases (13 ed.). Public Health Foundation.
p. Chapter 8. ISBN 9780990449119. Archived from the original
on 20 July 2016. Retrieved 14 July 2016.
^ Des Jardins, Terry (2015). Clinical Manifestations & Assessment
of Respiratory Disease (7 ed.). Elsevier Health Sciences. p. 529.
ISBN 9780323358972. Archived from the original on
^ Boons, Geert-Jan (2009). Carbohydrate-Based Vaccines and
Immunotherapies. Hoboken: John Wiley & Sons. p. 1222.
ISBN 9780470473276. Archived from the original on
^ Infectious Diseases. Lippincott Williams & Wilkins. 2004.
p. 461. ISBN 9780781733717. Archived from the original on
Epiglottitis at eMedicine
^ Mayo-Smith, Michael F.; Spinale, Joseph (1997). "Thermal
epiglottitis in adults: A new complication of illicit drug use". The
Journal of Emergency Medicine. 15 (4): 483–5.
doi:10.1016/S0736-4679(97)00077-2. PMID 9279700.
^ a b Damian Crowther. "management of epiglottitis - General Practice
Notebook". gpnotebook.co.uk. Dept. of Genetics, Downing Street,
Cambridge UK. Archived from the original on 8 September 2017.
Retrieved 2 June 2017.
Epiglottitis Imaging at eMedicine
^ Ito, Keiko; Chitose, Hiroko; Koganemaru, Masamichi (2011). "Four
cases of acute epiglottitis with a peritonsillar abscess". Auris Nasus
Larynx. 38 (2): 284–8. doi:10.1016/j.anl.2010.06.004.
Sarah Silverman 'lucky to be alive' after surgery".
apnews.com. Archived from the original on 11 August 2017. Retrieved 2
Sarah Silverman Says She Almost Died Last Week, Recounts Terrifying
ICU Story". etonline.com. Archived from the original on 2 June 2017.
Retrieved 2 June 2017.
^ Cavassuto, Maria (7 July 2016). "
Sarah Silverman Says 'Freak Case'
of Rare Condition Almost Killed Her". variety.com. Archived from the
original on 11 August 2017. Retrieved 2 June 2017.
^ Henriques, Peter R. (2000). The Death of George Washington: He Died
as He Lived. Mount Vernon, VA: Mount Vernon Ladies' Association.
pp. 27–36. ISBN 978-0-931917-35-6.
^ "Dec. 14, 1799: The excruciating final hours of President George
Washington". PBS NewsHour. Retrieved 31 December 2017.
V · T · D
ICD-9-CM: 464.3, 476.1
eMedicine: emerg/169 emerg/375 ped/700
Patient UK: Epiglottitis
Jordana Marinoff, "
Bacteria Grab a Windpipe and Hold it Hostage,"
Boston Globe, January 10, 2006
Diseases of the respiratory system (J, 460–519)
Nasal septum deviation
Nasal septum perforation
Nasal septal hematoma
Laryngopharyngeal reflux (LPR)
Laryngopharyngeal reflux (LPR)
Laryngopharyngeal reflux (LPR)
Vocal fold nodule
Vocal fold paresis
Vocal cord dysfunction
Lower RT/lung disease
Acute exacerbations of chronic bronchitis
Acute exacerbation of COPD
Asthma (Status asthmaticus
Bird fancier's lung
Löffler's syndrome/Eosinophilic pneumonia
Allergic bronchopulmonary aspergillosis
Idiopathic pulmonary fibrosis
Idiopathic pulmonary haemosiderosis