Inflammation of the epiglottis (epiglottitis)

Epiglottitis is an inflammation of the epiglottis. The epiglottis is a protective flap or “lid” of cartilage located at the top of the windpipe. During swallowing, it covers the windpipe to prevent any liquid or food from entering the airways.

Epiglottitis is usually caused by a bacterial infection. The inflammation causes the mucous membranes in the area around the epiglottis to become swollen.

If this causes a significant narrowing of the airways, severe breathing difficulties can arise. This is then a life-threatening situation, which can result in a risk of suffocation and respiratory failure. For this reason, it requires urgent emergency medical treatment. This situation occurs in children in particular but can also occur in adults in rare cases.

Difficulty swallowing, sore throat and a high temperature are other typical symptoms. In very young children up to pre-school age, epiglottitis is often caused by the bacterium known as Haemophilus influenzae type b (Hib). As a result, children who have not been vaccinated against Hib are more vulnerable to epiglottitis.

Epiglottitis can also affect people whose immune systems have been weakened – for example, due to cancer treatment or a HIV infection.

Children with epiglottitis usually have breathing difficulties, which may become as serious as respiratory distress and risk of suffocation. These symptoms can also occur suddenly and quickly become worse. Coughing is not typical of epiglottitis but can occur in rare cases in children.

Whistling or rasping sounds are typically heard when breathing in – the medical term for this is stridor. Often, children also prefer to be sitting or standing up rather than lying down. As a result, they may adopt the posture that is typical of people experiencing breathing difficulties – bent forward with the head tipped backwards to make breathing easier.

Other symptoms that commonly accompany epiglottitis in children and adults include:

• high temperature
• fatigue, tiredness, weakness
• feeling anxious and restless
• drooling
• sore throat, especially when swallowing

Adults with an inflammation of the epiglottis often experience changes to their voice and impaired speech. It may also hurt when the throat is touched or pressed from the outside.

Epiglottitis in children is usually caused by a bacterium known as Haemophilus influenzae type b (Hib). The same bacterium is also responsible for approximately a quarter of epiglottitis cases in adults.

It can also be caused by other types of bacteria or, more rarely, by viral or fungal infections or by injury.

An acute inflammation of the epiglottis is rare. The introduction of the Hib vaccine in 1990 has significantly reduced the number of people who develop an infection.

Among adults, the number of annual infections has remained stable for many years and, at 2 to 4 cases per 200,000 people, is now higher than the equivalent figure for children.

Vaccination against the pathogenic bacterium Haemophilus influenzae type b (Hib) prevents it from causing inflammation of the epiglottis. The Standing Committee on Vaccination in Germany (Ständige Impfkommission, STIKO) recommends the Hib vaccine for children up to the age of 4.

If a child is suspected of having an inflammation of the epiglottis, an ambulance should be called immediately (by dialing the emergency number 112).

Doctors usually begin by examining the patient’s symptoms, breathing and oxygen supply and finding out whether the child has been vaccinated against Haemophilus influenzae type b (Hib).

For a more precise diagnosis, the throat is examined using a laryngoscope (laryngeal mirror). Doctors will also take a swab from the epiglottis to detect a potential bacterial infection. However, special precautions must be taken when performing this test, as it could cause further irritation to the epiglottis.

Every case of epiglottitis needs to be treated in hospital as quickly as possible. Depending on the symptoms, the patient may require treatment in an intensive care unit.

To prevent complications due to respiratory distress, the swelling of the epiglottis must be brought down and breathing stabilized. Anti-inflammatory drugs can be used for this purpose.

If the patient is showing signs of oxygen deficiency, doctors can give them an oxygen mask. In some cases, use of a ventilator or a tracheotomy may be required.

As bacteria are the most common cause of epiglottitis, antibiotics are usually administered at an early stage. 

With prompt treatment, the symptoms usually clear up within a few days and the inflammation of the epiglottis heals without any lasting damage.