Sore throat – Epiglottitis
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, breathing difficulties, drooling and difficulty swallowing.
A swollen epiglottis can be very serious as it can restrict the oxygen supply to your lungs. Epiglottitis is therefore regarded as a medical emergency.
Dial 999 to request an ambulance if you think you or your child has epiglottitis.
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's important to keep them calm and to try not to cause panic or distress.
Epiglottitis can be fatal if the throat becomes completely blocked. However, with appropriate treatment most people make a full recovery.
Epiglottitis is treated in hospital. The first thing the medical team will do is make sure 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.
Most people with epiglottitis are well enough to leave hospital after 5-7 days.
Why it happens
Epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria, although it can also be caused by other types of bacteria or injury.
Since the 1990s, a vaccination against Hib bacteria has been routinely offered for young children. This has significantly reduced the number of Hib infections in children and young adults and is the best way to prevent epiglottitis.
The most effective way to protect your child against epiglottitis is to make sure that their vaccinations are up to date
Who is affected
Epiglottitis is rare in the UK. During 2011-12, fewer than 600 people were admitted to hospitals in England with the condition.
In the past epiglottitis was most common in children between the ages of two and four, but since the introduction of the Hib vaccine, most cases now occur in adults. In England during 2011-12, the average age of people admitted to hospital with the condition was 53.
Deaths from epiglottitis are also rare, occurring in less than 1 in 100 cases.
Symptoms of epiglottitis
The symptoms of epiglottitis usually develop quickly and get rapidly worse, although they can develop over a few days in older children and adults.
a severe sore throat
difficulty and pain when swallowing
difficulty breathing, which may improve when leaning forwards
breathing that sounds abnormal and high pitched (stridor)
a high temperature (fever) of 38ºC (100.4ºF) or above
irritability and restlessness
muffled or hoarse voice
The main symptoms of epiglottitis in young children are breathing difficulties, stridor and a hoarse voice. In adults and older children, the main signs are severe sore throat, swallowing difficulties and drooling.
When to seek medical advice
Dial 999 to request an ambulance if you suspect you, your child or someone you know has epiglottitis.
While waiting for an ambulance do not attempt to examine the throat, place anything inside the mouth or lie the person on their back because this can make their symptoms worse.
Causes of epiglottitis
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). As well as epiglottitis, Hib can cause a number of serious infections, such as pneumonia (infection of the lungs) and meningitis (infection of the outer membranes of the brain).
Due to the success of the Hib vaccination programme, Hib-related infections are rare. However, the vaccination is not 100% effective, which can result in someone being infected.
Hib bacteria are spread in a similar way to cold or 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.
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
viral infections, such as the varicella zoster virus (the virus responsible for chickenpox) and the herpes simplex virus (the virus responsible for cold sores)
trauma to the throat, such as a blow to the throat, or burning the throat by drinking very hot liquids
smoking, particularly illegal drugs such as cannabis or crack cocaine
In suspected cases of epiglottitis, the medical team's first priority is to ensure that you 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. See treating epiglottitis for more information.
Do not attempt to check the throat yourself because it can sometimes restrict the airway or even stop breathing altogether.
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, which could make them very anxious and increase their breathing difficulties.
A throat swab may be taken and tested to determine whether any bacteria or viruses are present.
Blood tests may also 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.
An X-ray or a computerised tomography (CT) scan is sometimes used to check the level of swelling.
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 you or 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 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 pushed past the epiglottis into the windpipe. The tube will be connected to an oxygen supply.
In severe cases where there is an urgent need to secure the airways, a cut may be made in the neck at the front of the windpipe so a tube can be inserted. The tube is then connected to an oxygen supply. This procedure is called a tracheostomy and it allows oxygen to enter the lungs while bypassing the epiglottis. An emergency tracheostomy can be carried out using local anaesthetic or general anaesthetic.
Once the airways have been secured and you are able to breathe unrestricted, a more comfortable and convenient way of assisting your breathing may be found. This is usually achieved by threading a tube through the nose and into the windpipe.
Until you are able to swallow, fluids will be supplied through a drip into one of your veins.
Treating the infection
Once you or your child is able to breathe unrestricted the source of the infection will be treated. As most cases of epiglottitis are caused by a bacterial infection, injections of broad spectrum antibiotics will be used.
Broad spectrum antibiotics are antibiotics 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 antibiotics for several days. As your symptoms improve, you may be given antibiotic tablets, capsules or liquids (oral antibiotics) rather than injections.
With prompt treatment, most people recover from epiglottitis after about a week. You or your child will usually be well enough to leave hospital after 5-7 days.
The most effective way to prevent your child getting epiglottitis is to make sure their vaccinations are up to date.
Children should receive their Haemophilus influenzae type b (Hib) as part of the 5 in 1 DTaP/IPV/Hib vaccine, which also protects against diphtheria, tetanus, whooping cough and polio.
Children should receive three doses of the vaccine: one at two months, one when they are three months and one when they are four months old. This is followed by an additional Hib/Men C ‘booster’ vaccine at 12 months.
As 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.
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.