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Epiglottitis

Introduction

Epiglottitis is inflammation and swelling of the epiglottis. In most cases it is caused by infection.

The epiglottis is a flap of tissue that sits beneath the tongue at the back of the throat. Its main function is to close over the windpipe (trachea) while you're eating to prevent food from entering your airways.

Symptoms of epiglottitis usually develop rapidly and include a severe sore throat, high temperature, drooling and difficulty swallowing.

A swollen epiglottis can be very serious as it's close to the windpipe and can restrict the oxygen supply to your lungs (respiratory failure). Epiglottitis is therefore regarded as a medical emergency.

Dial 999 to request an ambulance if your child has any of the symptoms of epiglottitis and is having problems breathing.

While waiting for an ambulance you should not attempt to examine your child's throat, place anything inside their mouth or lay them on their back because this may make their symptoms worse. It is important to keep them calm and to try not to cause panic or distress.

Left untreated, epiglottitis can be fatal. However, with appropriate treatment most children with epiglottitis will make a full recovery.

Treating epiglottitis

Epiglottitis is treated in hospital. The first thing the medical team will do is make sure that the airways are clear and your child is able to breathe. Once this has been achieved, the underlying infection will be treated with a course of antibiotics.

Read more about how epiglottitis is treated.

What causes epiglottitis?

Epiglottitis is usually caused by the Haemophilus influenzae type b (Hib) bacteria, although it can also be caused by other types of bacteria or injury.

Who gets epiglottitis?

Epiglottitis usually affects children between the ages of two and seven. However, since the Hib vaccine was introduced during the 1990s as part of the routine childhood vaccination schedule, epiglottitis is now very rare in England. Read more about preventing epiglottitis.

Cases of epiglottitis still sometimes occur because it can be caused by bacteria other than Hib. Also, the Hib vaccine may not always be 100% effective and many adults will not have received the vaccination.

It is estimated that each year in England there is one case of epiglottitis in every 200,000 children, and one case in every 100,000 adults. Deaths from epiglottitis are also very rare and occur in less than 1 in 100 cases.

Read more about the causes of epiglottitis.

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Symptoms

The symptoms of epiglottitis usually develop quickly and get rapidly worse.

Symptoms include:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • a severe sore throat
  • difficulty and pain when swallowing (dysphagia) - most children refuse to eat because of the pain
  • difficulty breathing
  • breathing that sounds abnormal and high pitched
  • bluish tinged skin (cyanosis)
  • muffled voice
  • drooling saliva

When to seek medical advice

Any situation in which a person suddenly develops breathing difficulties should be regarded as a medical emergency.

Dial 999 to request an ambulance if your child is having problems breathing.

While waiting for an ambulance do not attempt to examine your child's throat, place anything inside their mouth or lay them on their back because this may make their symptoms worse.

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Causes

The most common cause of epiglottitis is the Haemophilus influenzae type b (Hib) bacteria.

Children are particularly vulnerable to a Hib infection because they have an underdeveloped immune system (the body’s natural defence against infection and illness). Hib can cause a number of serious infections, including:

  • epiglottitis
  • pneumonia (infection of the lungs)
  • meningitis (infection of the outer membranes of the brain)

Due to the success of the Hib vaccination programme, Hib-related infections are rare. However, occasionally the vaccination does not work and this can result in someone being infected.

The Hib bacteria is spread in a similar way to cold or influenza (flu) viruses. People who are infected with the Hib bacteria (most of whom will not have any symptoms) can spread the virus when they cough or sneeze by releasing tiny droplets of saliva and mucus that contain the virus.

The infected droplets can also contaminate surfaces and objects. Anyone who places their hand on a contaminated surface or object and then touches their face or mouth may develop an infection.

Other causes

Less common causes of epiglottitis include:

  • other bacterial infections, such as streptococcus pneumoniae (a common cause of pneumonia)
  • fungal infections – people with a weakened immune system are most at risk from these types of infection
  • the varicella zoster virus – the virus responsible for chickenpox
  • trauma to the throat – such as a blow to the throat, or burning the throat by drinking very hot liquids
  • smoking illegal drugs, such as cannabis or crack cocaine
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Diagnosis

In suspected cases of epiglottitis, the medical team's first priority is to ensure that your child can breathe properly and that the lungs are getting enough oxygen.

Any tests that need to be done will only be carried out once this has been achieved. Read more about how the airways are cleared when treating epiglottitis.

Do not attempt to check the throat yourself because it can sometimes restrict the airway or even stop breathing altogether.

Fibre-optic laryngoscopy

A fibre-optic laryngoscopy is a procedure that uses a flexible tube with a camera attached to one end (laryngoscope) to examine your throat.

Fibre-optic laryngoscopies are usually only carried out in adults and older children. This is because younger children may find it difficult to understand why the procedure is being done, and it could make them very anxious and increase their breathing difficulties.

Other tests

Blood tests will usually be carried out to check the number of white blood cells (a high number indicates the presence of an infection). They can also help to identify any traces of bacteria or viruses in the blood.

In rare cases, a small sample of tissue (a biopsy) may also be taken from the epiglottis and tested to determine whether any bacteria or viruses are present.

If the diagnosis remains inconclusive an X-ray or a computerised tomography (CT) scan may be recommended.

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Treatment

Epiglottitis is a medical emergency that requires immediate treatment and admission to the nearest hospital.

The first priority in treating cases of epiglottitis is to ensure that your child is able to breathe. This is known as securing the airways.

Securing the airways

Your care team will initially try to improve your child's breathing by using an oxygen mask that delivers highly concentrated oxygen to the lungs. If this does not work, a tube will be placed in the mouth and will be pushed down past the epiglottis and into the windpipe. The tube will be connected to an oxygen supply.

If the situation is critical and there is an urgent need to secure the airways, a needle may be used to puncture an area of skin in the windpipe. This procedure is called a tracheostomy and allows oxygen to enter the lungs while bypassing the epiglottis.

After your child's airways have been secured and they are able to breathe unrestricted, a more comfortable and convenient way of assisting their breathing may be found. This is usually achieved by threading a tube through the nose and into the windpipe.

Treating the infection

Once your child is able to breathe unrestricted the source of the infection will be treated. The infection will be treated with injections of broad spectrum antibiotics.

Broad spectrum antibiotics are antibiotics that are designed to treat a wide range of different bacterial infections. Once the type of infection has been identified, a more specific type of antibiotic may be used.

Most people will need to take a seven- to ten-day course of antibiotics. As the symptoms improve, your child may be given antibiotic tablets (oral antibiotics) rather than injections (intravenous antibiotics).

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Prevention

The most effective way to prevent your child getting epiglottitis is to make sure that their vaccinations are up to date.

Children should receive their Haemophilus influenzae type b (Hib) as part of the combined DTaP/IPV/Hib vaccination. This also protects against diphtheria, polio, tetanus and whooping cough.

Children should receive three doses of the vaccine: one when they are two months, one when they are three months and one when they are four months old. This is followed by an additional ‘booster’ shot at the age of 12 months.

Children from developing countries may not have received the vaccination. Children who have immigrated into the UK should take part in the UK immunisation programme. Contact your GP if you are not sure whether your child’s vaccinations are up to date.

Read more about the childhood vaccination schedule.

A person in close contact with someone who has epiglottitis may also be given antibiotics to reduce the chance of the infection being passed on to them.

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