Epiglottitis

Supraglottitis

Epiglottitis is inflammation of the epiglottis. This is the tissue-lined cartilage that covers the trachea (windpipe) while swallowing. Epiglottitis can be a life-threatening disease.

Causes

The epiglottis is a stiff, yet flexible tissue (called cartilage) at the back of the tongue. It closes your windpipe (trachea) when you swallow so food does not enter your airway. This helps prevent coughing or choking after swallowing.

In children, epiglottitis is usually caused by the bacteria Haemophilus influenzae (H influenzae) type B. In adults, it is often due to other bacteria such as Streptococcus pneumoniae, or viruses such as herpes simplex virus and varicella-zoster.

Epiglottitis is now very uncommon because the H influenzae type B (Hib) vaccine is given routinely to all children. The disease was once most often seen in children ages 2 through 6. In rare cases, epiglottitis can occur in adults.

Symptoms

Epiglottitis begins with a high fever and sore throat. Other symptoms may include:

Abnormal breathing sounds (stridor)
Stridor
Stridor is an abnormal, high-pitched, musical breathing sound. It is caused by a blockage in the throat or voice box (larynx). It is most often hea...

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Fever
Blue skin color (cyanosis)
Cyanosis
A bluish color to the skin or mucous membrane is usually due to a lack of oxygen in the blood. The medical term is cyanosis.
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Drooling
Difficulty breathing (the person may need to sit upright and lean slightly forward to breathe)
Difficulty swallowing
Voice changes (hoarseness)

The airways can become totally blocked, which can result in cardiac arrest and death.

Exams and Tests

Epiglottitis can be a medical emergency. Seek medical help right away. Do not use anything to press the tongue down to try to look at the throat at home. Doing so may make the condition worse.

The health care provider may examine the voice box (larynx) using a small mirror held against the back of the throat. Or a viewing tube called a laryngoscope may be used. This examination is best done in the operating room or a similar setting where sudden breathing problems can be more easily handled.

Tests that may be done include:

Blood culture or throat culture
Blood culture
A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.
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Throat culture
A throat swab culture is a laboratory test that is done to identify germs that may cause infection in the throat. It is most often used to diagnose ...
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Complete blood count (CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Neck x-ray

Treatment

A hospital stay is needed, usually in the intensive care unit (ICU).

Treatment involves methods to help the person breathe, including:

Breathing tube (intubation)
Intubation)
Endotracheal intubation is a medical procedure in which a tube is placed into the windpipe (trachea) through the mouth or nose. In most emergency si...
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Moistened (humidified) oxygen
A surgical airway, called tracheostomy, as a last resort if other measures fail

Other treatments may include:

Antibiotics to treat the infection
Anti-inflammatory medicines, called corticosteroids, to decrease throat swelling
Fluids given through a vein (by IV)

Outlook (Prognosis)

Epiglottitis can be a life-threatening emergency. With proper treatment, the outcome is usually good.

When to Contact a Medical Professional

Seek immediate medical attention or call 911 or the local emergency number if a person has breathing trouble.

Difficulty breathing is a late, but important sign. Spasm may cause the airways to suddenly close. Or, the airways may become totally blocked. Either of these situations could result in death.

Prevention

The Hib vaccine protects most children from epiglottitis.

The most common bacteria (H influenza type b) that causes epiglottitis is easily spread. If someone in your family is sick from this bacteria, other family members need to be tested and treated.

Open References

References

Nayak JL, Weinberg GA. Epiglottitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 63.

Rodrigues KK, Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 433.

Epiglottis - illustration
The epiglottis is flap of cartilage located in the throat behind the tongue and in front of the larynx. The epiglottis is usually upright at rest allowing air to pass into the larynx and lungs. When a person swallows the epiglottis folds backward to cover the entrance of the larynx so food and liquid do not enter the windpipe and lungs. After swallowing the epiglottis returns to its original upright position.
Epiglottis
illustration
Throat anatomy - illustration
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
Throat anatomy
illustration
Haemophilus influenzae organism - illustration
This is a Gram stain of spinal fluid from a person with meningitis. The rod-like organisms seen in the fluid are Haemophilus influenzae, one of the most common causes of childhood meningitis (prior to the widespread use of the H influenzae vaccine). The large red-colored objects are cells in the spinal fluid. A vaccine to prevent infection by Haemophilus influenzae (type B) is available as one of the routine childhood immunizations (Hib), typically given at 2, 4, and 12 months.
Haemophilus influenzae organism
illustration
Haemophilus influenza organism - illustration
This picture shows the organism Haemophilus influenza. Infections caused by Haemophilus influenza usually occur in children under 6 years old and are extremely serious. Haemophilus (type B) is responsible for meningitis, periorbital cellulitis, buccal cellulitis and epiglottitis, septic arthritis, osteomyelitis, pericarditis, and bacteremia. The small organisms live within cells (intracellular) as shown in this picture. (Image courtesy of the Centers for Disease Control and Prevention.)
Haemophilus influenza organism
illustration

Epiglottis - illustration
The epiglottis is flap of cartilage located in the throat behind the tongue and in front of the larynx. The epiglottis is usually upright at rest allowing air to pass into the larynx and lungs. When a person swallows the epiglottis folds backward to cover the entrance of the larynx so food and liquid do not enter the windpipe and lungs. After swallowing the epiglottis returns to its original upright position.
Epiglottis
illustration
Throat anatomy - illustration
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
Throat anatomy
illustration
Haemophilus influenzae organism - illustration
This is a Gram stain of spinal fluid from a person with meningitis. The rod-like organisms seen in the fluid are Haemophilus influenzae, one of the most common causes of childhood meningitis (prior to the widespread use of the H influenzae vaccine). The large red-colored objects are cells in the spinal fluid. A vaccine to prevent infection by Haemophilus influenzae (type B) is available as one of the routine childhood immunizations (Hib), typically given at 2, 4, and 12 months.
Haemophilus influenzae organism
illustration
Haemophilus influenza organism - illustration
This picture shows the organism Haemophilus influenza. Infections caused by Haemophilus influenza usually occur in children under 6 years old and are extremely serious. Haemophilus (type B) is responsible for meningitis, periorbital cellulitis, buccal cellulitis and epiglottitis, septic arthritis, osteomyelitis, pericarditis, and bacteremia. The small organisms live within cells (intracellular) as shown in this picture. (Image courtesy of the Centers for Disease Control and Prevention.)
Haemophilus influenza organism
illustration

Tests for Epiglottitis

Review Date: 5/2/2024

Reviewed By: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Epiglottitis

Causes

H influenzae type B (Hib) vaccine

Symptoms

Stridor

Cyanosis

Exams and Tests

Blood culture

Throat culture

Complete blood count

Treatment

Intubation)

Outlook (Prognosis)

When to Contact a Medical Professional

Prevention

References

Epiglottis - illustration

Epiglottis

Throat anatomy - illustration

Throat anatomy

Haemophilus influenzae organism - illustration

Haemophilus influenzae organism

Haemophilus influenza organism - illustration

Haemophilus influenza organism