Epiglottitis: Symptoms, Causes & Treatment

Epiglottitis is a life-threatening inflammation of the epiglottis caused by bacteria. Shortness of breath, high fever and salivation are typical symptoms. The disease mainly affects small Indians and has become rare thanks to nationwide vaccinations. Read everything you need to know about epiglottitis here.

ICD codes for epiglottitis disease: J05 | J37

Quick overview

• Symptoms: Sudden onset of illness, severe feeling of illness, lumpy speech, swallowing hurts or is not possible, drooling, shortness of breath and choking attacks occur suddenly (medical emergency).

• Causes and risk factors: Usually infection with the bacterium Haemophilus influenza type B, more rarely Streptococcus pneumoniae or Staphylococcus aureus; insufficient vaccination protection against HiB is a risk factor, especially in adults.

• Diagnosis: Visual diagnosis by the doctor, as few further examinations as possible to avoid suffocation, artificial respiration or tracheotomy prepared as an emergency, rarely tracheotomy.

• Treatment: Usually artificial respiration, administration of antibiotics via the bloodstream against the bacteria, administration of cortisone preparations to curb the inflammation.

• Prognosis: Treated usually healing after a few days without consequences, suffocation attacks are fatal in ten to 20 percent of cases.

• Prevent: Vaccination against Haemophilus influenza type B (HiB vaccination) in infancy is an effective lifelong protection.

What is epiglottitis?

Epiglottitis is an inflammation of the epiglottis, usually caused by the bacterium Haemophilus influenzae type B. More rarely – more commonly in adults – the bacteria Streptococcus pneumoniae (“pneumococci”) or Staphylococcus aureus trigger the inflammation.

The epiglottis lies above the trachea and serves to close it off during swallowing. Inflammation of the epiglottis causes swelling of the mucous membranes on and around the epiglottis. This narrows the trachea, which often leads to shortness of breath.

The condition is acutely life-threatening, as there is a risk of suffocation due to the swollen epiglottis.

If you suspect epiglottitis, you should therefore call an emergency doctor immediately. If the patient threatens to suffocate, he must be artificially ventilated as soon as possible.

Treated in time, the epiglottis usually heals without serious consequences.

Although epiglottitis occurs more often in small children between the ages of two and six, it is basically possible for all age groups to develop it. An increase in cases in older children or adults has been observed, particularly since widespread vaccination.

Overall, however, the number of diseases is decreasing – epiglottitis has now become a rare disease.

A likely prominent historical victim of epiglottitis is the first President of the United States, George Washington.

Symptoms of epiglottitis

Epiglottitis: Symptoms, Causes & Treatment

Epiglottitis is always an emergency. Because acute shortness of breath often develops within a very short time of six to twelve hours after the onset of the disease. Therefore, call an emergency doctor immediately, even if it turns out that the symptoms may have been caused by another illness.

If you have the following symptoms, you probably have epiglottitis:

  • Those affected appear very ill and complain of a severe sore throat when speaking.
  • The fever is over 39 degrees Celsius and starts suddenly.
  • The language is “clunky”.
  • Swallowing is usually no longer possible.
  • The lymph nodes in the neck are swollen.
  • Because of the difficulty in swallowing, those affected are unable to swallow their own saliva, which is why it often runs out of their mouths.
  • Some patients do not want to speak or are unable to.
  • Breathing becomes difficult and sounds like snoring (rattling breathing). One of the reasons for this is that a pool of saliva has formed in the throat.
  • The jaw is stretched forward and the mouth is open.
  • The sitting posture of those affected is bent forward while the head is tilted back (coach seat) because breathing is easier this way. Victims refuse to lie down.
  • Patients are pale and/or bluish.
  • Increasing shortness of breath.

Life-threatening suffocation attacks are possible with an inflammation of the epiglottis – then call an ambulance and an emergency doctor immediately!

Epiglottitis vs pseudocroup

Epiglottitis is easily confused with viral pseudocroup. Both epiglottitis and what is known as pseudocroup (stenosing laryngotracheitis) are inflammations in the pharynx and therefore have similar symptoms, such as swelling of the epiglottis.

However, while epiglottitis is a life-threatening condition, pseudocroup is usually harmless. There are the following differences:

PathogenUsually the bacterium Haemophilus influenzae type BMostly viruses, eg the parainfluenza virus
General conditionSevere malaise, high feverUsually not significantly affected
Beginning of the diseaseSuddenly out of the best of health, rapidly deterioratingSlower, progressive onset of disease

Hoarseness and coughing do not occur with epiglottitis.

Causes and risk factors

Epiglottitis is usually caused by an infection with the bacterium Haemophilus influenzae type B. Rarely, other bacteria such as streptococci and staphylococci are responsible for the inflammation of the epiglottis. Since the introduction of the Haemophilus influenzae type B vaccination (HiB vaccination), the disease has occurred much less frequently.

In some cases, those affected have a banal infection, such as a runny nose or a slight sore throat, before the epiglottitis. In most cases, however, those affected become ill from perfect, excellent health. In contrast to the much more common pseudocroup, there is no seasonal accumulation of epiglottitis, epiglottis inflammation occurs at all times of the year.

Haemophilus influenzae type B

The bacterium Haemophilus influenzae type B, which causes epiglottitis, colonizes the mucous membrane of the respiratory tract (nose, pharynx, trachea) and can lead to inflammation there. It is transmitted by coughing, speaking or sneezing (droplet infection).

The incubation period, i.e. the period between infection and the first symptoms, is two to five days. In the past, the bacterium was mistaken for the trigger of the flu (influenza) and was therefore called “influenzae”.

Diagnosis of epiglottitis

For the experienced doctor, epiglottitis is a “sight diagnosis”, which means that he can recognize the disease by simply inspecting the patient. The examinations are limited to what is absolutely necessary, since fear and manipulation in the pharynx often aggravate the shortness of breath and trigger an attack of suffocation, especially in children.

The doctor only performs a physical examination if there are no breathing difficulties. Equipment for artificial respiration and at least oxygen should always be available if it develops.

The doctor then inspects the oral cavity and pharynx with a spatula. In children, the inflamed epiglottis of the epiglottitis can be recognized by carefully pushing the tongue away.

If necessary, a laryngoscopy or a bronchoscopy is necessary. The epiglottis is noticeably reddened and swollen.

If the affected person is gasping for air and has turned blue (cyanosis), it is advisable to start artificial respiration (intubation) at an early stage. To do this, a breathing tube is placed over the mouth or nose into the throat to secure the airways.

Under certain circumstances, this is made more difficult by the swollen epiglottis, which is why the doctor has to make a tracheostomy in an emergency. The doctor prepares these measures as a precaution during the examination.

How is epiglottitis treated?

Epiglottitis is treated in hospital and in intensive care. In the clinic, the patient is closely monitored and, if necessary, artificially ventilated. Infusions through a vein supply it with nutrients and regulate the fluid balance.

In addition, he receives intravenously administered antibiotics such as cefotaxime or cephalosporins over a period of ten days. Furthermore, the treating person gives cortisone (glucocorticoid) via the vein, so that the inflammation of the epiglottis decreases. A pump spray with epinephrine helps to relieve acute shortness of breath.

If there is a threat of respiratory arrest, the patient is immediately intubated, which can be difficult due to the epiglottitis. An adrenaline spray is also administered.

Sedatives such as benzodiazepines must not be given under any circumstances, as these drugs often increase shortness of breath. In rare and severe cases, when intubation is not possible through the swelling, a tracheostomy (cricothyrotomy, tracheostomy) is performed.

As a rule, the patient is artificially ventilated for about two days. He will only be released if there are no more complaints for more than 24 hours.

Measures until the emergency doctor arrives

In the event of epiglottitis, you should calm the patient down until the emergency doctor arrives, because unnecessary excitement often worsens the shortness of breath. Therefore, in no case should you try to look down your throat.

Open the windows for fresh air. Open tight clothing. Pay attention to the attitude the person concerned wants to adopt.

The coachman’s seat, with the trunk bent forward, the arms supported on the thighs and the head held up, often makes it easier to breathe.

Course of the disease and prognosis

With timely therapy, the symptoms improve within a few days and the epiglottitis heals without any consequential damage. If epiglottitis is recognized or treated too late, it can have a fatal outcome.

Asphyxiation is the most feared complication of epiglottitis. It ends fatally in 10 to 20 percent of cases.

Prevention of epiglottitis

Since the bacterium Haemophilus influenzae type B is the main cause of epiglottitis, the so-called HiB vaccination provides effective protection.

The Standing Vaccination Committee (STIKO) of the Robert Koch Institute (RKI) recommends vaccination for all infants from the second month of life. It is usually given as a six-fold vaccination together with vaccines against hepatitis B, tetanus, diphtheria, polio and whooping cough.

According to the reduced 2+1 vaccination scheme that STIKO has been recommending since June 2020, infants receive the HiB vaccination in the second, fourth and eleventh month of life. Premature babies, on the other hand, get four vaccination shots (an additional one in the third month of life).

Booster vaccinations are not necessary after complete basic immunization. Primary immunization is important to build up adequate vaccination protection that effectively prevents epiglottitis.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.