Epiglottitis: Symptoms, Causes, and Emergency Care in the UK

Epiglottitis is the medical term for inflammation and swelling of the epiglottis. The epiglottis is a small, leaf-shaped flap of cartilage located at the base of your tongue. Its primary function is to act as a lid, closing over your windpipe (trachea) when you swallow to prevent food and liquid from entering your lungs.

When the epiglottis becomes infected or injured, it can swell rapidly. Because of its position at the entrance of the respiratory tract, a swollen epiglottis can obstruct the airway, making it difficult or even impossible to breathe. Therefore, while it may start with symptoms similar to a common sore throat, epiglottitis is classified as a medical emergency in both children and adults.

The symptoms of epiglottitis usually develop quickly and worsen over a matter of hours. In children, the onset is often very rapid, whereas, in adults, it may develop more gradually over a couple of days. Key signs to look out for include:

• Severe sore throat: A sudden and extremely painful throat that makes swallowing difficult.
• Drooling: Because swallowing is so painful, many people find they cannot swallow their own saliva.
• Stridor: A high-pitched, whistling sound when breathing in, indicating a partially blocked airway.
• Muffled voice: Often described as a 'hot potato' voice, where speech sounds thick or muffled.
• Difficulty breathing: The person may lean forward or sit in a 'tripod position' (hands on knees, leaning forward) to try and open their airway.
• High fever: Usually a temperature of 38°C or above.

In the past, the most common cause of epiglottitis was infection with Haemophilus influenzae type b (Hib) bacteria. However, since the introduction of the Hib vaccine into the standard UK childhood routine immunisation schedule in the early 1990s, the number of cases has dropped significantly.

Despite the success of the vaccine, epiglottitis can still occur due to other causes, including:

• Other Bacteria: Such as Streptococcus pneumoniae (which also causes pneumonia) or Staphylococcus aureus.
• Fungal Infections: More common in individuals with weakened immune systems.
• Physical Injury: A blow to the throat or swallowing a foreign object.
• Burns: Drinking very hot liquids or inhaling smoke or steam.
• Smoking: Inhaling chemicals or drugs (such as crack cocaine) can cause chemical irritation and swelling.

If epiglottitis is suspected, medical professionals prioritise securing the airway before any diagnostic tests are performed. Crucially, you should never attempt to look down the person's throat or press on the tongue with a spoon or spatula at home, as this can trigger a spasm that completely closes the airway.

In a hospital setting, doctors may use a fibre-optic camera (laryngoscope) to safely view the throat. Treatment usually involves:

• Airway support: Providing oxygen through a mask or, in severe cases, placing a tube into the windpipe (intubation) to assist breathing.
• Intravenous (IV) fluids: To ensure hydration when the patient cannot swallow.
• Antibiotics: To treat the underlying bacterial infection.
• Steroids: To help reduce the swelling of the epiglottis.

The most effective way to prevent the most common bacterial cause of epiglottitis is to ensure that children receive their routine vaccinations. In the UK, the Hib vaccine is given as part of the '6-in-1' vaccine at 8, 12, and 16 weeks of age, followed by a booster at one year.

While the vaccine provides excellent protection, it does not prevent epiglottitis caused by other bacteria or injuries. Maintaining good hygiene and seeking prompt medical advice for worsening throat symptoms remains important for all age groups.

A mild sore throat or a common cold can usually be managed at home with rest and over-the-counter remedies. However, you should consult an online GP or your local surgery if a sore throat persists for more than a few days, is worsening, or you are concerned about your symptoms.

You should call 999 immediately or go to the nearest A&E if you or someone else experiences:

• Difficulty breathing or rapid breathing.
• Difikulty swallowing or excessive drooling.
• A high-pitched noise (stridor) when breathing.
• Blue or grey-tinged lips or skin (cyanosis).
• Extreme restlessness or confusion due to lack of oxygen.