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JAMA Patient Page
May 21, 2019

Epiglottitis

Author Affiliations
  • 1Stanford Hospital, Stanford, California
  • 2Pediatric Critical Care, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
JAMA. 2019;321(19):1946. doi:10.1001/jama.2019.3468

Epiglottitis can cause airway obstruction and inability to breathe, particularly in children.

The epiglottis is a flap of cartilage that sits in the back of the throat and closes over the airway during swallowing so that food and liquids do not go into the lungs. A bacterium called Haemophilus influenzae, among others, can infect the epiglottis, causing it to swell up and possibly block the airway. This causes serious difficulty breathing and can become life-threatening. Epiglottitis usually affects children younger than 5 years, but it can occur in older patients as well.

Symptoms and Diagnosis

Children with epiglottitis usually have a fever (temperature >101.4 °F or >38.5 °C), sore throat, difficulty swallowing, and difficulty moving the neck downward, but they may not necessarily appear ill at first. There is typically no cough, and the back of the mouth might look normal or slightly red. However, difficulty breathing can develop rapidly, and timely diagnosis is essential. As an infection progresses, a child may show behavior such as sitting upright, leaning forward, and being very still but breathing rapidly; drooling may occur because the child cannot swallow his or her own saliva. The child’s voice may seem thick and muffled.

Diagnosis is made with a physical examination and a neck x-ray that shows the inflamed epiglottis. Laboratory tests can be useful to culture the bacteria, but the results usually take a few days. Croup is a similar upper respiratory tract infection caused by various viruses and can be distinguished by a typical barking cough.

Treatment

It is important to recognize epiglottitis quickly to provide rapid, appropriate treatment. As the infection progresses, a child is in danger of not being able to breathe because of the airway closing. If epiglottitis is suspected, contact the child’s pediatrician, call 911, or take the child to the nearest emergency department. Reassuring the child to prevent crying or being afraid is important, as anxiety can make the airway more likely to close. A clinician will provide oxygen to the child. If epiglottitis is suspected and the child is having difficulty breathing, a breathing tube will be placed by an experienced physician. Antibiotics are crucial to treating the infection.

Considerations

Haemophilus influenzae, the most common cause of epiglottitis, is a dangerous bacterium that can cause not only epiglottitis but also meningitis, pneumonia, and other life-threatening infections. Incidence of infection with this pathogen has decreased substantially in the last 30 years because of the H influenzae type B (Hib) vaccine. Children should receive a vaccination at age 2, 4, and 6 months as well as a final/booster dose at age 12 to 15 months. Sometimes, if Hib vaccine is part of a combination vaccine, the child will need fewer shots. Usually, children older than 5 years and adults do not need the Hib vaccine unless they have problems with their spleen or certain blood disorders that predispose them to this infection. The vaccine is 90% to 95% effective, but it does not contain all the strains of Hib. Epiglottitis therefore can still occur despite vaccination, and early recognition and timely treatment can be lifesaving. Vaccinating children against Hib is the best means of protecting them.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. 2008;122(8):818-823. doi:10.1017/S0022215107000473

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