Epiglottitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken.
Epiglottitis is classically described in children aged 2 to 6 years of age; however, it may manifest at any age, including in newborns. In countries that have introduced routine Haemophilus influenzae type B (Hib) vaccination, it is now extremely rare in children and may be more common in adults.
The most common signs are rapid onset of high fever, sore throat, inability to control secretions, classic tripod positioning, difficulty breathing, and irritability. Adults may have a more indolent presentation and may not require airway intervention (only about 11% of adults require intubation whereas most children do).
Cooperation between the otolaryngologist, pediatrician, or emergency room physician and anesthesiologist is crucial.
No action should be taken that could stimulate a child with suspected epiglottitis, including examination of the oral cavity, starting intravenous lines, blood draws, or even separation from a parent. Similar caution is required in fulminant acute epiglottitis in adults.

Lateral neck film demonstrating thumbprint sign (arrows)

From the collection of Dr Petri

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Lateral neck film demonstrating thumbprint sign (arrows)

Citations

Key Articles

Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenza type B vaccine era: changing trends. 2004 Mar;114(3):557-60.[Abstract]
Wong EY, Berkowitz RG. Acute epiglottitis in adults: the Royal Melbourne Hospital experience. ANZ J Surg. 2001 Dec;71(12):740-3.[Abstract]

Referenced Articles

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3. Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenza type B vaccine era: changing trends. 2004 Mar;114(3):557-60.[Abstract]
4. Wong EY, Berkowitz RG. Acute epiglottitis in adults: the Royal Melbourne Hospital experience. ANZ J Surg. 2001 Dec;71(12):740-3.[Abstract]
5. Yoon TM, Choi JO, Lim SC, et al. The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis. Clin Otolaryngol. 2010;35:18-24.[Abstract]
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7. Acevedo JL, Lander L, Choi S, et al. Airway management in pediatric epiglottitis: a national perspective. Otolaryngol Head Neck Surg. 2009 Apr;140(4):548-51.[Abstract]
8. Hanna J, Brauer PR, Berson E, et al. Adult epiglottitis: trends and predictors of mortality in over 30 thousand cases from 2007 to 2014. Laryngoscope. 2019 May;129(5):1107-12.[Abstract]
9. Guardiani E, Bliss M, Harley E. Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: evolving principles in diagnosis and management. Laryngoscope. 2010 Nov;120(11):2183-8.[Abstract]
10. Sideris A, Holmes TR, Cumming B, et al. A systematic review and meta-analysis of predictors of airway intervention in adult epiglottitis. Laryngoscope. 2020 Feb;130(2):465-73.[Abstract]
11. Freeman L, Wolford R. Acute epiglottitis caused by methicillin-resistant Staphylococcus aureus in adults. Clin Infect Dis. 1998 May;26(5):1240-1.[Abstract][Full Text]
12. Isakson M, Hugosson S. Acute epiglottitis: epidemiology and Streptococcus pneumoniae serotype distribution in adults. J Laryngol Otol. 2011 Apr;125(4):390-3.[Abstract]
13. Harris PJ, Osswald MB. Pasteurella multocida epiglottitis: a review and report of a new case with associated chronic lymphocytic leukemia. Ear Nose Throat J. 2010 Dec;89(12):E4.[Abstract][Full Text]
14. Vigil KJ, Mulanovich VE, Chemaly RF, et al. Severe parainfluenza virus type 2 supraglottitis in an immunocompetent adult host: an unusual cause of a paramyxoviridae viral infection. J Intern Med. 2009;265:397-400.[Abstract]
15. Lo WC, Lee SY, Hsu WC. Isolating Candida epiglottitis. Otolaryngol Head Neck Surg. 2010;142:630-1.[Abstract]
16. Centers for Disease Control and Prevention. Haemophilus influenzae invasive disease among children aged less than 5 years - California, 1990-1996. MMWR Morb Mortal Wkly Rep. 1998 Sep 11;47(35):737-40.[Abstract][Full Text]
17. Ladhani SN, Davila S, Hibberd ML, et al. Association between single-nucleotide polymorphisms in Mal/TIRAP and interleukin-10 genes and susceptibility to invasive haemophilus influenzae serotype b infection in immunized children. Clin Infect Dis. 2010 Oct 1;51(7):761-7. [Abstract][Full Text]
18. Kong MS, Engel SH, Zalzal GH, et al. Necrotizing epiglottitis and hemophagocytic lymphohistiocytosis. Int J Pediatr Otorhinolaryngol. 2009 Jan;73(1):119-25.[Abstract]
19. Berger G, Landau T, Berger S, et al. The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Otolaryngol. Nov-Dec 2003;24(6):374-83. [Abstract]
20. Cressman WR, Myer CM 3rd. Diagnosis and management of croup and epiglottitis. Pediatr Clin North Am. 1994 Apr;41(2):265-76.[Abstract]
21. Navaratnam AV, Smith ME, Majeed A, et al. Adult supraglottitis: a potential airway emergency that can present in primary care. Br J Gen Pract. 2015 Feb;65(631):99-100.[Abstract][Full Text]
22. Médecins Sans Frontières. Clinical guidelines - diagnosis and treatment manual. Mar 2024 [internet publication].[Full Text]
23. Lindquist B, Zachariah S, Kulkarni A. Adult Epiglottitis: a case series. Perm J. 2017;21:16-089.[Abstract][Full Text]
24. McEwan J, Giridharan W, Clarke RW. Paediatric acute epiglottitis: not a disappearing entity. Int J Pediatr Otorhinolaryngol. 2003 Apr;67(4):317-21.[Abstract]
25. Dowdy RAE, Cornelius BW. Medical management of epiglottitis. Anesth Prog. 2020 Jun 1;67(2):90-7.[Abstract]
26. Vermelis AM, Mateijsen N, Giebelen D, et al. Successful use of videolaryngoscopy in an adult patient with acute epiglottitis: a case report. Acta Anaesthesiol Belg. 2010;61(2):67-70.[Abstract]
27. Sobol SE, Zapata S. Epiglottitis and croup. Otolaryngol Clin North Am. 2008 Jun;41(3):551-66;ix.[Abstract]
28. Milani FE, Shams Vahdati S, Paknejad P. Successful outcome of mediastinitis after 26 days delay in diagnosis. Turk J Emerg Med. 2014 Jun;14(2):84-6.[Abstract][Full Text]