Epiglottitis: Symptoms, Types, Causes and Treatment

Epiglottitis is a potentially life-threatening condition that affects the upper airway, specifically the epiglottis—a leaf-shaped flap of tissue that prevents food and liquids from entering the windpipe during swallowing. Once considered a pediatric emergency, epiglottitis is now more frequently observed in adults, largely due to widespread childhood vaccination. Rapid recognition and intervention are essential to prevent serious complications, including airway obstruction. In this article, we explore the symptoms, types, causes, and treatment options for epiglottitis, drawing on the latest research and clinical experience.

Symptoms of Epiglottitis

Recognizing epiglottitis early can be a lifesaver. Although symptoms may overlap with other throat and airway infections, some features are particularly suggestive of this condition. Both children and adults can be affected, but their presentations may differ. Understanding these symptoms helps prompt early diagnosis and intervention.

Symptom	Description	Typical Onset	Source(s)
Sore throat	Severe, sudden, and persistent	Early	1 3 9 12
Dysphagia	Painful, difficult swallowing	Early	1 3 8 9
Respiratory distress	Shortness of breath, stridor	Rapid progression	1 3 4 8 12
Muffled voice	"Hot potato" voice, hoarseness	Early to mid-stage	2 3 8 9
Drooling	Inability to swallow saliva	Early to mid-stage	2 8 9 12
Fever	Often present, variable intensity	Early	2 9 12
Stridor	High-pitched breathing sound	Advanced/critical	8 9 12
Tripod position	Leaning forward, neck extended	Advanced/critical	9
Neck pain/stiffness	Especially in children	Early	2

Table 1: Key Symptoms

Overview of Symptom Presentation

Symptoms of epiglottitis tend to develop rapidly, often over a few hours in children and over a day or two in adults. The classic triad includes severe sore throat, dysphagia (painful swallowing), and respiratory distress. These symptoms can quickly escalate, making timely recognition crucial 1 3 9 12.

Differentiating Signs

• Sore Throat and Dysphagia: These are typically the earliest and most prominent symptoms. The pain is often disproportionate to the appearance of the throat on initial examination 3 9.
• Muffled Voice and Drooling: The swelling of the epiglottis alters the voice, producing a muffled or "hot potato" quality. Drooling occurs because swallowing becomes too painful or difficult 2 3 8.
• Respiratory Distress, Stridor, and Tripod Position: As the airway narrows, patients may develop noisy breathing (stridor), difficulty breathing, and may assume a sitting posture with the chin thrust forward (tripod position) to ease airflow 8 9.
• Fever and Systemic Symptoms: While fever is common, it may not always be present, particularly in adults 9 12.

Age-Related Differences

• Children: More likely to present with sudden respiratory distress, high fever, drooling, and stridor. They may refuse to lie down and appear anxious 2 9 12.
• Adults: Symptoms may be more subtle, with predominant severe sore throat, dysphagia, and voice changes. Respiratory distress is less common but requires urgent attention when present 3 8 15.

Types of Epiglottitis

Epiglottitis is traditionally thought of as a single disease, but it can manifest in various forms depending on the patient’s age, underlying health, and causative organism. Understanding the types can help tailor treatment and anticipate complications.

Type	Patient Group / Setting	Distinguishing Features	Source(s)
Classical Acute	Children (historically), Adults	Rapid onset, airway risk	6 9 10 12
Adult Epiglottitis	Adults	Subtler, sometimes less severe	3 4 8 12
Fungal Epiglottitis	Immunocompromised	Candida infection, slower onset	7
Abscess-related	Both	Epiglottic or periepiglottic abscess	16
Viral-associated	All ages	Rare, e.g., COVID-19	11

Table 2: Types of Epiglottitis

Classical (Acute) Epiglottitis

This form is characterized by rapid inflammation and swelling of the epiglottis, traditionally seen in young children but now more common in adults. It carries the highest risk of sudden airway compromise 6 9 12.

Adult Epiglottitis

Adults present more frequently with epiglottitis today, often with less dramatic symptoms. The disease course can be more gradual, but severe cases still occur. Adult patients may have underlying comorbidities, such as diabetes, increasing their risk 3 4 8 12 15.

Fungal Epiglottitis

This rare type occurs in immunocompromised individuals, such as those with cancer or on immunosuppressive therapy. Candida species are the most common culprits. The infection may be localized or part of a wider systemic infection 7.

Abscess-Related Epiglottitis

Sometimes, abscesses can form in or around the epiglottis, complicating the clinical course. This can result in a slower onset and may not require airway intervention as urgently as classical cases, but still needs close monitoring 16.

Viral-Associated Epiglottitis

Emerging reports suggest that viruses, such as SARS-CoV-2 (the virus causing COVID-19), can also trigger epiglottitis, either directly or via post-infectious inflammatory pathways 11.

Causes of Epiglottitis

A variety of pathogens and non-infectious triggers can cause epiglottitis. Identifying the cause is key for targeted treatment and public health measures, such as vaccination and prophylaxis for contacts.

Cause	Common Examples / Pathogens	Prevalence/Significance	Source(s)
Bacterial	H. influenzae type b, Streptococcus, Staphylococcus	Most common, especially in adults since Hib vaccination	4 8 9 10 14
Viral	Influenza, Parainfluenza, SARS-CoV-2	Less common, emerging	10 11
Fungal	Candida species	Rare, immunocompromised	7
Non-infectious	Caustic/thermal injuries, autoimmune	Rare	8 9

Table 3: Causes of Epiglottitis

Bacterial Etiologies

• Haemophilus influenzae type b (Hib): Historically the most common cause in children. The widespread use of Hib vaccine has dramatically reduced childhood cases, shifting the disease burden to adults 4 9 10 14.
• Streptococcus and Staphylococcus species: Now leading causes in adults, particularly in the post-Hib vaccine era 8 9 10.
• Other Bacteria: Neisseria, Moraxella, and others are occasional causes 8 9.

Viral Causes

While rare, viruses, including influenza, parainfluenza, and, more recently, SARS-CoV-2, have been implicated in epiglottitis. Viral cases may follow or coincide with typical respiratory infections 10 11.

Fungal and Non-Infectious Causes

• Fungal: Candida epiglottitis is rare and usually seen in patients with weakened immune systems, such as those undergoing chemotherapy 7.
• Non-infectious: Epiglottitis can also result from thermal burns (e.g., inhalation of hot liquids), caustic ingestions, or autoimmune diseases, though these are much less common 8 9.

Changing Epidemiology

The introduction of the Hib vaccine has dramatically altered the epidemiology of epiglottitis. While once a disease of young children, cases are now more common in adults, and are often caused by bacteria other than Hib 4 10 12.

Treatment of Epiglottitis

Management of epiglottitis centers around rapid assessment and protection of the airway, followed by targeted antimicrobial therapy. Treatment approaches have evolved, particularly with the shift in patient demographics and causative organisms.

Intervention	Purpose/Method	Patient Group / Setting	Source(s)
Airway Management	Intubation, tracheostomy, observation	All, especially those with distress	1 3 8 9 12 15
Antibiotics	IV cephalosporins, penicillins, chloramphenicol	All, tailored to likely pathogen	9 13 14 15
Steroids	Reduce airway swelling (controversial)	Selected cases	3 8 9 11
Antifungals	For confirmed fungal cases	Immunocompromised	7
ICU Monitoring	Close airway, cardiorespiratory observation	All, especially severe cases	9 12 13 15
Supportive Care	Hydration, oxygen, nebulized epinephrine	All, case-dependent	9 11
Prophylaxis	Rifampicin for contacts	Hib exposure cases	4 14

Table 4: Treatment Strategies

Airway Protection: The First Priority

• Assessment: Initial management always prioritizes the airway. Signs of impending obstruction (stridor, respiratory distress, tripod position) require immediate intervention 1 3 8 9 12 15.
• Intervention: Intubation is preferred if feasible, but tracheostomy may be necessary in severe cases where intubation fails 3 11 15. In adults, some cases can be managed conservatively with close monitoring if airway compromise is not imminent 12 16.
• Pediatric vs. Adult Approach: Children more often require airway intervention, while adults may be observed safely if symptoms are not severe 12 16.

Antimicrobial Therapy

• Empirical Antibiotics: Broad-spectrum intravenous antibiotics are started immediately, covering likely pathogens (e.g., third-generation cephalosporins such as ceftriaxone or cefotaxime) 9 13 14 15.
• Antibiotic Selection: In penicillin-allergic patients, alternatives like clindamycin and chloramphenicol are used 13 14.
• Duration: Short courses (e.g., two doses of ceftriaxone) may be effective in children, while adults typically require a full course of IV antibiotics 14 15.

Adjunctive Therapies

• Steroids: May reduce airway swelling, but their routine use is debated. They may be reserved for cases with significant edema or as part of multi-modal management in severe cases 3 8 9 11.
• Antifungal Agents: For patients with confirmed fungal epiglottitis, intravenous antifungals such as amphotericin B are indicated 7.

Monitoring and Supportive Care

• ICU Admission: Most patients are monitored in an intensive care or high-dependency setting for potential airway deterioration 9 12 13 15.
• Supportive Measures: These include intravenous fluids, oxygen supplementation, and sometimes nebulized epinephrine for airway swelling 9 11.
• Prophylaxis for Contacts: In cases of Hib epiglottitis, close contacts may require prophylactic rifampicin 4 14.

Outcomes and Special Considerations

• Prognosis: With prompt treatment, outcomes are generally good, especially in adults. Delayed recognition or failure to secure the airway remains the major risk for mortality 12 15.
• Immunocompromised Patients: Require close monitoring and possible alternative antimicrobial therapy 7 15.

Conclusion

Epiglottitis remains a medical emergency despite evolving epidemiology. Timely recognition, airway management, and targeted therapy are crucial for favorable outcomes. Key takeaways include:

• Epiglottitis symptoms are often severe, with sore throat, dysphagia, and respiratory distress being the most common and concerning features.
• Types of epiglottitis include classical, adult, fungal, abscess-related, and viral-associated forms, each with unique clinical implications.
• Causes have shifted from predominantly Hib in children to a broader range of bacteria in adults, with occasional viral, fungal, or non-infectious triggers.
• Treatment hinges on early airway assessment, rapid initiation of antibiotics, and intensive monitoring, with airway intervention as needed.

Remember: Epiglottitis, though less common in the era of vaccination, remains a critical diagnosis not to be missed—swift action can save lives.

Main Points Covered:

• Early recognition and intervention are vital due to risk of airway obstruction.
• Symptoms include severe sore throat, dysphagia, muffled voice, drooling, fever, and respiratory distress.
• Types: Classical/acute, adult, fungal, abscess-related, and viral-associated.
• Causes: Mainly bacterial, with rising cases in adults; rare viral, fungal, and non-infectious cases.
• Treatment: Airway protection, IV antibiotics, possible steroids, ICU monitoring, and specific therapies for special populations.