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.

This restricts the entry of air into the windpipe, which can lead to severe shortness of breath and respiratory distress. This is a life-threatening situation, which can result in a risk of suffocation and respiratory failure. For this reason, it requires urgent emergency medical treatment.

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. However, they do not normally have a cough.

Whistling or rasping sounds may also be 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 adopt the posture that is typical of people experiencing breathing difficulties – bent forward with the head tipped backwards to make breathing easier.

Other typical symptoms that accompany epiglottitis include:

• high temperature
• fatigue, tiredness, weakness
• feeling anxious and restless
• drooling

In contrast, the main symptoms of epiglottitis in adults are sore throat and difficulties with swallowing. If the saliva cannot be swallowed, this can affect speech and cause drooling from the mouth.

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.

In the past, around 10 in every 200,000 children under the age of 4 developed epiglottitis every year – but today, this figure has dropped to around 1 child in every 200,000.

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.

Inflammation of the epiglottis can be prevented by vaccination against the pathogenic bacterium Haemophilus influenzae type b (Hib). 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 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.

Every case of epiglottitis must be treated as quickly as possible in a hospital and, depending on the symptoms, 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. In most cases, anti-inflammatory drugs are 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.

It is also important to pinpoint the cause of the epiglottitis in each case. If the patient has a bacterial infection, this can be treated effectively with an antibiotic.

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